1
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Rathore S, Khanra D, Galassi AR, Boukhris M, Tsuchikane E, Dens J, Mashayekhi K, Grantham JA, Brilakis ES, Karmpaliotis D, Werner GS. Procedural characteristics and outcomes following chronic total occlusion coronary intervention: pooled analysis from 5 registries. Expert Rev Cardiovasc Ther 2021; 19:929-938. [PMID: 34714700 DOI: 10.1080/14779072.2021.1997590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent improvements in clinical skills, technology, and hardware have resulted in improved success rates with chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We performed a study level pooled analysis from the five largest registries of percutaneous coronary intervention (PCI) of CTO. RESEARCH DESIGN AND METHODS We conducted pooled analysis of 9500 patients in registries and data on procedural characteristics, technical success, and MACCE was collected. RESULTS A total of 9500 patients were included in the analysis. Mean age was 65.4 years with previous CABG in 24.8%, reattempt procedure in 24.8% and mean JCTO score was 2.2. Final wiring strategy in hybrid algorithm-based registries was AWE in 40.8-58%, Retrograde in 24-35%, ADR in 16-25% and in Expert JCTO and EURO CTO was AWE in 72-75% and retrograde in 25-28%. Technical success was achieved in 87.8%. In hospital MACCE was 2.5% (95% CI: 1.8- 3.4%), mortality 0.44% (95% CI: 0.23-0.84%), stroke 0.2% (95% CI: 0.1-0.3%); myocardial infraction 1.6% (95% CI: 1.1-2.2%); and cardiac tamponade 0.8% (95% CI: 0.5 to 1.3%). CONCLUSION CTO PCI is currently performed with high technical success rates and low complication rates in experienced hands utilizing various techniques.
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Affiliation(s)
- Sudhir Rathore
- Department Of Cardiology, Frimley Health NHS Foundation Trust, Surrey, UK
| | - Dibbendu Khanra
- Department Of Cardiology, New Cross Hospital, Wolverhampton, UK
| | | | | | - Etsuo Tsuchikane
- Department Of Cardiology, Toyohashi Heart Centre, Toyohashi, Japan
| | - Joseph Dens
- Department Of Cardiology, Ziekenhuis Oost-Limburg, Belgium
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - J Aaron Grantham
- Department Of Cardiology, University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, USA
| | - Emmanouil S Brilakis
- Department Of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Das D, Acharya D, Singh J, Pramanik S. A detailed review of management of coronary perforations by gelfoam closure. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_45_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Coronary artery perforation complicated by recurrent cardiac tamponade: a case illustration and review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:S30-S34. [DOI: 10.1016/j.carrev.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 11/19/2022]
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4
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Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher D, Abdullah S, Banerjee S, Brilakis ES. Angiographic Success and Procedural Complications in Patients Undergoing Percutaneous Coronary Chronic Total Occlusion Interventions. JACC Cardiovasc Interv 2013; 6:128-36. [PMID: 23352817 DOI: 10.1016/j.jcin.2012.10.011] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/11/2012] [Indexed: 12/20/2022]
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5
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Ziakas A, Economou F, Feloukidis C, Kiratlidis K, Stiliadis I. Left anterior descending artery perforation treated with graft stenting combining dual catheter and side branch graft stenting techniques. Herz 2012; 37:913-6. [DOI: 10.1007/s00059-012-3645-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022]
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6
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Senguttuvan NB, Ramakrishnan S, Gulati GS, Seth S, Bhargava B. How should I treat guidewire-induced distal coronary perforation? EUROINTERVENTION 2012; 8:155-63. [PMID: 22580259 DOI: 10.4244/eijv8i1a23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Copeland KA, Hopkins JT, Weintraub WS, Rahman E. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv 2011; 80:53-7. [DOI: 10.1002/ccd.23339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/08/2011] [Indexed: 11/09/2022]
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8
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Kim JH, Kim MK, Kim YJ, Park SM, Park KH, Choi YJ. Is a metallic microcoil really a permanent embolic agent for the management of distal guidewire-induced coronary artery perforation? Korean Circ J 2011; 41:474-8. [PMID: 21949533 PMCID: PMC3173669 DOI: 10.4070/kcj.2011.41.8.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 03/31/2011] [Indexed: 11/15/2022] Open
Abstract
Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but serious complication. It can cause cardiac tamponade, acute myocardial infarction or death. The treatments of CAP involve prolonged balloon inflation, emergent surgery, coil embolization, and implantation of covered stent. We have successfully performed the emergent microcoil embolization in a patient with uncontrolled Ellis grade 3 guidewire-induced CAP resulting in delayed cardiac tamponade. Contrasting our usual expectation, the 1-year follow-up angiography showed a patent flow at the embolized site.
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Affiliation(s)
- Jae Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical School, Hangang Sacred Heart Hospital, Seoul, Korea
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9
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Trana C, Muller O, Roguelov C, Eeckhout E. Deciding on the best course of action for grade III coronary perforations. Interv Cardiol 2011. [DOI: 10.2217/ica.11.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Intracoronary thrombin injection using a microcatheter to treat guidewire-induced coronary artery perforation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:329-33. [PMID: 21367674 DOI: 10.1016/j.carrev.2010.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/09/2010] [Indexed: 11/22/2022]
Abstract
Coronary artery perforation (CAP) is an infrequent yet a very dangerous complication of percutaneous coronary intervention. We describe the successful treatment of a guidewire-induced distal coronary branch vessel perforation using localized distal injection of intracoronary thrombin with a microcatheter. This technique appears to be safe and effective for the treatment of life-threatening distal guidewire perforations, even in the smallest tertiary coronary branches.
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11
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Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Mussardo M, Arioli F, Carlino M, Montorfano M, Chieffo A, Colombo A. Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation. JACC Cardiovasc Interv 2011; 4:87-95. [PMID: 21251634 DOI: 10.1016/j.jcin.2010.08.026] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/26/2010] [Accepted: 08/06/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention. BACKGROUND Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality. METHODS From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation. RESULTS Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤ 2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%. CONCLUSIONS Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates.
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Affiliation(s)
- Rasha Al-Lamee
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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12
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Kiernan TJ, Yan BP, Ruggiero N, Eisenberg JD, Bernal J, Cubeddu RJ, Witzke C, Don C, Cruz-Gonzalez I, Rosenfield K, Pomersantev E, Palacios I. Coronary artery perforations in the contemporary interventional era. J Interv Cardiol 2010; 22:350-3. [PMID: 19453819 DOI: 10.1111/j.1540-8183.2009.00469.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Coronary perforations represent a serious complication of percutaneous coronary intervention (PCI). METHODS We performed a retrospective analysis of documented coronary perforations at Massachusetts General Hospital from 2000 to 2008. Medical records review and detailed angiographic analysis were performed in all patients. RESULTS Sixty-eight cases of coronary perforation were identified from a total of 14,281 PCIs from March 2000 to March 2008 representing an overall incidence of 0.48%. The study cohort was predominantly male (61.8%), mean age 71+/-11 years with 78% representing acute cases (unstable angina: 36.8%, NSTEMI: 30.9%, STEMI: 10.3%). Coronary artery perforation occurred as a complication of wire manipulation in 45 patients (66.2%) with 88.9% of this group being hydrophilic wires, of coronary stenting in 11 (16.2%), of angioplasty alone in 6 (8.8%), and of rotational atherectomy in 8 (11.8%). The perforation was sealed with an angioplasty balloon alone in 16 patients (23.5%), and with stents in 14 patients (20.6%) (covered stents: 11.8% and noncovered stents: 8.8%). Emergency CABG was performed in 2 patients (2.9%). Five patients (7.4%) developed periprocedural MI. The in-hospital mortality rate was 5.9% in the study cohort. CONCLUSION Coronary artery perforation as a complication of PCI is still rare as demonstrated in our series with an incidence of 0.48%. The predominant cause of coronary perforations in the current era of PCI is wire injury.
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Affiliation(s)
- T J Kiernan
- Division of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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13
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Gilchrist IC. Seal it to heal it: potential option for distal wire perforation. Catheter Cardiovasc Interv 2009; 73:795-6. [PMID: 19367633 DOI: 10.1002/ccd.22071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Matsumi J, Adachi K, Saito S. A unique complication of the retrograde approach in angioplasty for chronic total occlusion of the coronary artery. Catheter Cardiovasc Interv 2008; 72:371-378. [PMID: 18727117 DOI: 10.1002/ccd.21638] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The retrograde approach for chronic total occlusion of coronary arteries is a new treatment strategy, although its attendant complications have not yet been fully appreciated. We report a case of isolated left ventricular cardiac tamponade caused by guidewire-induced perforation of the septal branch during the retrograde approach, which was subsequently diagnosed by computed tomography (CT) and which required surgical drainage. Guidewire-induced perforation of the septal branch was successfully treated by autologous subcutaneous tissue embolization of the perforated coronary artery. This is the first case of its kind to date.
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Affiliation(s)
- Jyunya Matsumi
- Division of Cardiology and Catheterization Laboratories, Heart Center of ShonanKamakura General Hospital, Yamazaki, Kamakura City, Japan
| | - Koichi Adachi
- Division of Cardiology and Catheterization Laboratories, Heart Center of ShonanKamakura General Hospital, Yamazaki, Kamakura City, Japan
| | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Heart Center of ShonanKamakura General Hospital, Yamazaki, Kamakura City, Japan
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15
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Shah A, Lau C, Stavropoulos SW, Nemeth A, Soulen MC, Solomon JA, Mondschein JI, Patel AA, Shlansky-Goldberg RD, Itkin M, Chittams JL, Trerotola SO. Comparison of Physician-rated Performance Characteristics of Hydrophilic-coated Guide Wires. J Vasc Interv Radiol 2008; 19:400-5. [DOI: 10.1016/j.jvir.2007.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 09/21/2007] [Accepted: 09/22/2007] [Indexed: 11/16/2022] Open
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16
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Störger H, Ruef J. Closure of guide wire-induced coronary artery perforation with a two-component fibrin glue. Catheter Cardiovasc Interv 2007; 70:237-40. [PMID: 17420994 DOI: 10.1002/ccd.21115] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perforation or rupture of a coronary artery with subsequent pericardial effusion and cardiac tamponade is a potentially life-threatening complication of percutaneous coronary intervention (PCI). Several emergency treatment strategies exist to close the perforation including reversal of anticoagulation, prolonged balloon inflation, implantation of stent grafts, local injection of thrombogenic molecules, placement of microcoils, or open heart surgery. Here we report on a 66-year-old patient who underwent urgent PCI for acute stent thrombosis in the proximal LAD. The artery was reopened, a new stent implanted successfully, and a GPIIb/IIIa-antagonist was given. Shortly thereafter the patient suffered from cardiac tamponade requiring pericardiocentesis and pericardial drainage. The coronary angiogram indicated a severe guide wire-induced perforation and pericardial effusion originating from a distal diagonal branch segment. Prolonged balloon inflation did not stop the leakage. Therefore the monorail balloon was exchanged for an over-the-wire balloon. A two-component commercial fibrin glue consisting of fibrinogen and thrombin was rapidly but separately injected through the wire channel of the balloon into the distal segment of the diagonal branch. The coronary leak was successfully closed and the patient recovered quickly. In comparison with the previously reported cases of thrombin injection important differences should be noticed: (1) a two-component hemostatic seal was used without reversal of anticoagulation, (2) rapid injection instead of prolonged infusion of the hemostatic drugs was performed, and (3) the rescue technique was applied in a cath lab that routinely uses monorail catheter systems. Therefore we consider this a novel and effective approach for closure of coronary ruptures.
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Affiliation(s)
- Hans Störger
- Red Cross Hospital Cardiology Center, Frankfurt, Germany
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17
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Javaid A, Buch AN, Satler LF, Kent KM, Suddath WO, Lindsay J, Pichard AD, Waksman R. Management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2006; 98:911-4. [PMID: 16996872 DOI: 10.1016/j.amjcard.2006.04.032] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 04/21/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
Coronary perforation is a particularly feared complication of percutaneous coronary intervention. The optimal management and predictors of adverse outcomes for these patients remain to be defined. Advances in management such as the use of polytetrafluoroethylene-covered stents have not been critically examined in terms of efficacy. We analyzed a cohort of patients who sustained coronary perforation during percutaneous coronary intervention at our institution during a 9-year period to examine the trends in incidence, management, and outcomes. The patient medical records were reviewed, and detailed angiographic analysis was undertaken to identify the predictors of adverse outcomes, including the development of tamponade, the requirement for emergency coronary artery bypass grafting, and in-hospital death. One year of follow-up was attempted for all patients. Seventy-two cases of coronary perforation were identified, with an overall incidence of 0.19%. The perforation grade and presence of chronic renal insufficiency were the only predictors of mortality on multivariate regression analysis. The use of polytetrafluoroethylene-covered stents to manage perforations was not associated with any reduction in adverse outcomes, such as the development of tamponade, the need for emergency coronary artery bypass grafting, or in-hospital death. In conclusion, coronary perforation remains a feared complication in the contemporary interventional era with significant in-hospital mortality. Emphasis should be placed on preventing this complication whenever possible, including exercising particular caution in patients with chronic renal insufficiency. The treatment of such patients should be tailored to the severity of the perforation. The optimal treatment of these patients needs to be defined, and the efficacy of covered stents needs to be studied prospectively.
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18
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Fischell TA, Carter AJ, Ashraf K, Birdsall J, Smoker S. Coronary artery rupture during balloon angioplasty, rescued with localized thrombin injection and coil embolization. Catheter Cardiovasc Interv 2006; 68:254-7. [PMID: 16819769 DOI: 10.1002/ccd.20714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Distal intracoronary thrombin injection has been used successfully to seal very small, guidewire related, coronary artery perforations during percutaneous coronary intervention. This case report expands upon this therapeutic approach, by describing the use of high dose distal thrombin injection for the successful (non-surgical) management of balloon-induced coronary artery rupture, with an intrapericardial leak.
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Affiliation(s)
- Tim A Fischell
- Heart Institute at Borgess Medical Center, Michigan State University, Kalamazoo, Michigan 490048, USA.
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19
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Martí V, Castaño C, Guiteras P, Vallés E, Domínguez de Rozas JM, Augé JM. Perforación coronaria complicada con taponamiento cardíaco sellada mediante coils metálicos. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77228-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Yilmaz H, Demir I, Sancaktar O, Basarici I. Successful management of osteal perforation of left anterior descending artery with coated stent. Int J Cardiol 2003; 88:293-6. [PMID: 12714210 DOI: 10.1016/s0167-5273(02)00382-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary perforation is a rare complication of percutaneous coronary intervention. We report a case of left anterior descending artery osteal perforation that led to acute cardiac tamponade during excimer laser angioplasty. Perforation was successfully covered with a PTFE-coated stent with preserved distal coronary flow.
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21
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Fischell TA, Korban EH, Lauer MA. Successful treatment of distal coronary guidewire-induced perforation with balloon catheter delivery of intracoronary thrombin. Catheter Cardiovasc Interv 2003; 58:370-4. [PMID: 12594705 DOI: 10.1002/ccd.10440] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Distal coronary artery perforation with a coronary guidewire is a relatively rare but potentially fatal complication during PTCA. Historically, these types of perforations have been easy to control with reversal of heparin anticoagulation combined with prolonged distal balloon inflation. In the modern era, with widespread use of potent glycoprotein IIb/IIIa inhibitors, this type of distal wire perforation has become more difficult to manage and potentially lethal. In this article, we report two cases of guidewire-related distal coronary artery perforation, successfully treated using a new technique using localized, distal intracoronary thrombin injection. During prolonged low-pressure balloon inflation, a small dose of thrombin was injected just proximal to the wire perforation site via the lumen of a coronary balloon catheter. This approach appears to be a relatively rapid and effective way to control this troublesome complication.
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Affiliation(s)
- Tim A Fischell
- Department of Medicine, Michigan State University, Kalamazoo, Michigan 49048, USA.
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22
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Aslam MS, Messersmith RN, Gilbert J, Lakier JB. Successful management of coronary artery perforation with helical platinum microcoil embolization. Catheter Cardiovasc Interv 2000; 51:320-2. [PMID: 11066117 DOI: 10.1002/1522-726x(200011)51:3<320::aid-ccd18>3.0.co;2-u] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A case of small coronary artery perforation during coronary intervention is presented. Continued leakage occurred despite prolonged intracoronary balloon inflation, in part probably related to the use of glycoprotein (GP) IIB/IIIA inhibitors. It was successfully managed by microcoil embolization without any sequel, helping avoid surgery in a high-risk patient. Cathet. Cardiovasc. Intervent. 51:320-322, 2000.
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Affiliation(s)
- M S Aslam
- Division of Cardiology, Lutheran General Hospital, Park Ridge, Illinois 60068, USA.
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23
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Gruberg L, Pinnow E, Flood R, Bonnet Y, Tebeica M, Waksman R, Satler LF, Pichard AD, Kent KM, Leon MB, Lindsay J. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2000; 86:680-2, A8. [PMID: 10980224 DOI: 10.1016/s0002-9149(00)01053-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have analyzed the incidence, management, and outcome of 84 cases of coronary artery perforation in patients who underwent percutaneous coronary intervention at our institution. This complication was more frequent in female patients and in patients who underwent lesion modification with atheroablative devices. A total of 8 patients (9.5%) died after the procedure. They were usually older and had a higher incidence of cardiac tamponade; a larger percentage of these patients underwent emergency surgery than those who survived.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/mortality
- Angioplasty, Balloon, Laser-Assisted/adverse effects
- Angioplasty, Balloon, Laser-Assisted/mortality
- Atherectomy, Coronary/adverse effects
- Atherectomy, Coronary/mortality
- Cineangiography
- Coronary Angiography
- Coronary Disease/therapy
- Coronary Vessels/injuries
- Female
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Rupture
- Survival Rate
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Affiliation(s)
- L Gruberg
- Section of Cardiology, Washington Hospital Center, DC 20010, USA
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24
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Sheiban I, Dharmadhikari A, Tzifos V, Marsico F, Leonardo F, Rosano G, Montorfano M, Pagnotta P, Di Mario C, Colombo A. Recanalization of chronic total coronary occlusions: the impact of a new specific guidewire on primary success rate. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2000; 3:105-110. [PMID: 12470377 DOI: 10.1080/14628840050516190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND: Although chronic total occlusions are encountered frequently in patients with coronary artery disease, an effective strategy to deal with them has yet to be devised. Various new guidewires have been designed in an attempt to negotiate chronic occlusions successfully. The authors have analysed the impact of the Athlete guidewire on procedural success in this lesion subset. METHODS: Sixty-two consecutive patients undergoing percutaneous intervention for chronic total occlusions over a two-year period were retrospectively studied. For the initial attempt, conventional guidewires were used. In case of failure, further attempts were made using the Athlete guidewire. Procedural success rates with the use of conventional and Athlete guidewires were assessed. RESULTS: Failure of the first attempt with the conventional guidewire occurred in 32 (51.6%) patients and success was achieved in 30 (48.4%) patients. In the former patients, a second attempt was made using the Athlete guidewire to cross the occlusion. The second attempt was successful in 20 patients (60%) in whom the first attempt was unsuccessful, while in the remaining 12 (40%) patients the occlusion could not be crossed even during the second attempt and the procedure was then terminated. Following the use of the Athlete guidewire, the success rate increased to 62% (p < 0.001). No complication occurred during the first attempt, while one patient had a coronary perforation using the Athlete guidewire, which was managed successfully without the need for bypass surgery. CONCLUSION: The use of the Athlete guidewire is feasible and safe, and enhances the chances of successfully treating chronic total occlusions during percutaneous coronary revascularization procedures.
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Affiliation(s)
- Imad Sheiban
- Department of Internal Medicine, Cardiology Unit - Interventional Cardiology, University of Turin, Italy
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25
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Lefèvre T, Louvard Y, Loubeyre C, Dumas P, Piéchaud JF, Krol M, Benslimane A, Premchand RK, Morice MC. A randomized study comparing two guidewire strategies for angioplasty of chronic total coronary occlusion. Am J Cardiol 2000; 85:1144-7, A9. [PMID: 10781769 DOI: 10.1016/s0002-9149(00)00713-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic total coronary occlusions were more frequently crossed using the Crosswire as a primary guidewire strategy than with the conventional strategy. This strategy resulted in a lower number of guidewires being used, a trend toward shorter procedural and fluoroscopy times, and decreased use of contrast media.
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Affiliation(s)
- T Lefèvre
- Institut Cardiovasculaire Paris Sud, Massy, France
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26
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Abstract
A guidewire-induced distal coronary artery perforation presenting with cardiac tamponade was occluded by distal Gelfoam embolization via an infusion catheter. This extends the treatment options for this rare complication of coronary interventional procedures. Cathet. Cardiovasc. Intervent. 49:214-217, 2000.
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Affiliation(s)
- S R Dixon
- Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
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27
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COTO HUMBERTO. Emergency Platinum Coil Embolization in a Coronary Artery Perforation with Tamponade During Abciximab Infusion in Acute Myocardial Infarction. J Interv Cardiol 1999. [DOI: 10.1111/j.1540-8183.1999.tb00260.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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Meier B. The hydrophilic guidewire: the poor man's laser for chronic total coronary occlusions for the good and for the bad. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 44:91-2. [PMID: 9600532 DOI: 10.1002/(sici)1097-0304(199805)44:1<91::aid-ccd21>3.0.co;2-r] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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