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Moroni F, Brilakis ES, Azzalini L. Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Rev Cardiovasc Ther 2021; 19:71-87. [PMID: 33175595 DOI: 10.1080/14779072.2021.1850264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Coronary artery perforation (CAP) is an infrequent (<1%) complication of percutaneous coronary intervention (PCI), that can lead to dramatic consequences, including tamponade and death. The incidence of CAP is higher (4-9%) in chronic total occlusion (CTO) PCI due higher complexity of these lesions and the techniques used to recanalized them. AREAS COVERED In this Expert Review, we discuss the specific features of CTO PCI predisposing to CAP. We also describe the typical procedural scenarios in which CAP can occur and provide a universal management algorithm. Currently available devices and techniques for CAP treatment are presented in detail. Finally, we discuss imaging support for diagnosis of pericardial effusion in CAP as well as medical and surgical management. EXPERT OPINION With increasing volumes and complexity of CTO PCI, the incidence of CAP is likely to rise. Adherence to good catheterization laboratory practices, availability of dedicated equipment to seal CAP, perform pericardiocentesis, and provide hemodynamic support, as well as adequate training, are pillars for the prevention and optimal management of CAP during CTO PCI.
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Affiliation(s)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
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2
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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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Gasparini GL, Merella P, Mazzarotto P, Gagnor A, Garbo R, Oreglia JA. Retrograde approach-related epicardial collateral channel perforation successfully treated with simultaneous bilateral coils embolization: A case illustration and review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:879-886. [DOI: 10.1016/j.carrev.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/02/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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4
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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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5
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Chin Yong A, Wei Chieh JT. Coronary Perforation Complicating Percutaneous Coronary Intervention - A Case Illustration and Review. ACTA ACUST UNITED AC 2014; 21:3. [PMID: 26316662 PMCID: PMC4544476 DOI: 10.7603/s40602-013-0002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI). Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.
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Affiliation(s)
- Ang Chin Yong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
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6
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Asouhidou I, Katsaridis V. Successful embolization of iatrogenic ruptured coronary artery using Onyx: A new technique. ACTA ACUST UNITED AC 2014; 16:123-6. [DOI: 10.3109/17482941.2014.944541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7
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Goel PK, Syal SK. A unique and unexplained ricochet leak post PCI - successfully treated with intra-coronary glue. Indian Heart J 2014; 66:122-6. [PMID: 24581110 PMCID: PMC4054828 DOI: 10.1016/j.ihj.2013.12.031] [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: 03/13/2013] [Revised: 10/03/2013] [Accepted: 12/05/2013] [Indexed: 11/22/2022] Open
Abstract
We herein describe a unique case of coronary artery perforation treated with covered stent with repeat cardiac tamponade resulting out of a fresh unexplained leak from a remote vessel (Ricochet) and successfully treated with intra-coronary injection of sterile synthetic glue, cyanoacrylate.
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Affiliation(s)
- Pravin K Goel
- Professor & Head, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Sanjeev K Syal
- Senior Resident, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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8
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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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9
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Renal artery perforation related with hydrophilic guide wire during coronary intervention: successful treatment with polyvinyl alcohol injection. Can J Cardiol 2012; 28:612.e5-7. [PMID: 22575577 DOI: 10.1016/j.cjca.2012.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/29/2012] [Accepted: 03/12/2012] [Indexed: 11/23/2022] Open
Abstract
Hydrophilic guide wire-related renal artery perforation (RAP) and subsequent retroperitoneal hemorrhage (RPH) during coronary angiography (CAG) is very rare. We present the case of a 68-year-old woman who suffered accidental hydrophilic 0.035-inch guide wire piercing-related RAP and RPH during CAG and coronary intervention. This RAP was diagnosed by bedside ultrasonography and selective renal angiography, and was successfully treated by transcatheter polyvinyl alcohol injection.
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10
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Coronary Artery Perforation During Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. Can J Cardiol 2011; 27:843-50. [DOI: 10.1016/j.cjca.2011.04.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 11/23/2022] Open
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11
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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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12
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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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13
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Hashida H, Funada JI, Morioka N, Iwata T. The lurking potential of tangential forces: A case of an arteriovenous shunt developed by percutaneous coronary intervention for the septal branch. J Cardiol Cases 2010; 1:e1-e5. [DOI: 10.1016/j.jccase.2009.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 05/01/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022] Open
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14
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Kawano H, Arakawa S, Satoh O, Matsumoto Y, Hayano M, Miyabara S. Foreign body granulomatous change from absorbable gelatin sponge and microcoil embolization after a guidewire-induced perforation in the distal coronary artery. Intern Med 2010; 49:1871-4. [PMID: 20823648 DOI: 10.2169/internalmedicine.49.3750] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report an autopsy case of treatment by absorbable gelatin sponge and microcoil embolization after perforation of the distal coronary artery by guidewire. Histological examination revealed a foreign body granuloma in the coronary artery with embolization. Foreign body reaction to absorbable gelatin sponge seemed to be stronger than that to the microcoil.
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MESH Headings
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Anticoagulants/therapeutic use
- Autopsy
- Coronary Vessels/injuries
- Coronary Vessels/pathology
- Embolization, Therapeutic/adverse effects
- Embolization, Therapeutic/instrumentation
- Gelatin Sponge, Absorbable/adverse effects
- Granuloma, Foreign-Body/etiology
- Granuloma, Foreign-Body/pathology
- Heart Failure/etiology
- Hemostatic Techniques
- Humans
- Male
- Stents
- Wounds, Penetrating/etiology
- Wounds, Penetrating/therapy
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiology, Nagasaki Rosai Hospital, Japan.
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15
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Kini AS, Rafael OC, Sarkar K, Rajdev S, Jakkula M, Mares AM, Kaplish D, Krishnan P, Kim MC, Sharma SK. Changing outcomes and treatment strategies for wire induced coronary perforations in the era of bivalirudin use. Catheter Cardiovasc Interv 2009; 74:700-7. [DOI: 10.1002/ccd.22112] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Aleong G, Jimenez-Quevedo P, Alfonso F. Collagen embolization for the successful treatment of a distal coronary artery perforation. Catheter Cardiovasc Interv 2009; 73:332-5. [PMID: 19133686 DOI: 10.1002/ccd.21823] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 42-year old man suffered a coronary artery perforation in the right coronary artery secondary to a hydrophilic guidewire. We describe for the first time the use of collagen embolization to successfully treat this complication.
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Affiliation(s)
- Godfrey Aleong
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
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17
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Muller O, Windecker S, Cuisset T, Fajadet J, Mason M, Zuffi A, Doganov A, Eeckhout E. Management of two major complications in the cardiac catheterisation laboratory: the no-reflow phenomenon and coronary perforations. EUROINTERVENTION 2009; 4:181-3. [PMID: 19110779 DOI: 10.4244/eijv4i2a32] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Olivier Muller
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
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18
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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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19
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To ACY, El-Jack SS, Webster MWI, Stewart JT. Coronary artery perforation successfully treated with tris-acryl gelatin microsphere embolisation. Heart Lung Circ 2007; 17:423-6. [PMID: 17660046 DOI: 10.1016/j.hlc.2007.06.521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 05/17/2007] [Accepted: 06/13/2007] [Indexed: 10/23/2022]
Abstract
We describe a case of coronary artery perforation in a 76-year-old man, successfully treated by tris-acryl gelatin microsphere embolisation. This novel interventional embolic material is used in interventional radiology for arterial embolisation. We believe that this is the first report of its use for a coronary artery perforation.
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Affiliation(s)
- Andrew C Y To
- The Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
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20
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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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21
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Oda H, Oda M, Makiyama Y, Kashimura T, Takahashi K, Miida T, Higuma N. Guidewire-induced coronary artery perforation treated with transcatheter delivery of subcutaneous tissue. Catheter Cardiovasc Interv 2005; 66:369-74. [PMID: 16208712 DOI: 10.1002/ccd.20522] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In three cases of small coronary artery perforation by guidewires during percutaneous coronary intervention, coronary leakage continued despite prolonged balloon inflation and reversal of heparin. Subcutaneous tissue was selectively delivered to perforated vessels by means of microcatheters in a successful attempt to stop leakage. This method appears to be extremely effective for treating guidewire-induced perforations of distal coronary arteries.
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Affiliation(s)
- Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan.
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22
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Silva JA, Stant J, Ramee SR. Endovascular treatment of a massive retroperitoneal bleeding: Successful balloon-catheter delivery of intra-arterial thrombin. Catheter Cardiovasc Interv 2005; 64:218-22. [PMID: 15678443 DOI: 10.1002/ccd.20251] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Retroperitoneal bleeding is a potentially lethal complication of percutaneous intervention, when the common femoral artery is used as vascular access. Surgery, the traditional treatment for this complication in patients with persistent bleeding or hemodynamic instability, carries a considerable risk of morbidity and mortality. We report a case of life-threatening retroperitoneal bleeding successfully treated percutaneously with balloon occlusion and catheter delivery of thrombin to attain thrombosis of a lacerated branch of the common femoral artery. Endovascular catheter-based percutaneous treatment for massive retroperitoneal bleeding is often effective and should be pursued in selected patients.
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Affiliation(s)
- Jose A Silva
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana 70461, USA.
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23
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Panetta CJ, Fasseas P, Raveendran G, Garratt KN. Pseudoperforation during kissing balloon angioplasty. Catheter Cardiovasc Interv 2004; 63:290-3. [PMID: 15505864 DOI: 10.1002/ccd.20172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe a case of apparent perforation during kissing balloon angioplasty of a bifurcation lesion. There was no evidence of perforation on follow-up angiography or via intravascular ultrasound. Possible etiologies include minimal perforation that immediately sealed postdeflation or forced contrast into the microvascular bed via a proximal side branch.
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Affiliation(s)
- Carmelo J Panetta
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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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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Mulvihill NT, Boccalatte M, Sousa P, Farah B, Laborde JC, Fajadet J, Marco J. Rapid sealing of coronary perforations using polytetrafluoroethylene-covered stents. Am J Cardiol 2003; 91:343-6. [PMID: 12565095 DOI: 10.1016/s0002-9149(02)03166-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niall T Mulvihill
- Unite De Cardiologie Interventionnelle, Clinique Pasteur, Toulouse, France.
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Londero HF. Artery perforation during catheterization: fighting with a catastrophe. Catheter Cardiovasc Interv 2002; 57:44-6. [PMID: 12203926 DOI: 10.1002/ccd.10282] [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: 11/05/2022]
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