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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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Caixeta A, Ybarra LF, Latib A, Airoldi F, Mehran R, Dangas GD. Coronary Artery Dissections, Perforations, and the No-Reflow Phenomenon. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Luiz Fernando Ybarra
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Azeem Latib
- San Raffaele Scientific Institute; Milan Italy
| | | | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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Gu G, Zhang J, Cui W. Treatment of right ventricular perforation during percutaneous coronary intervention. Cardiovasc J Afr 2015; 26:e4-6. [PMID: 26592991 PMCID: PMC4763480 DOI: 10.5830/cvja-2014-072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/27/2014] [Indexed: 11/06/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is widely used to treat stenotic coronary arteries caused by coronary heart disease. Coronary artery perforation is a rare but dreaded complication of PCI. Here, we report the successful treatment of a patient with coronary perforation of the right ventricular cavity. To our knowledge, this is the first report of its kind. The patient was a 69-year-old woman with intermittent chest tightness and chest pain of about five years' duration who was hospitalised for severe chest tightness and pain persisting for three days. She had a history of hypertension and hyperlipidaemia; routine admission examination showed no other abnormalities. Results of routine blood, urine and stool tests, liver and kidney function, clotting time, electrocardiogram, chest radiography and echocardiography were normal. Although coil embolisation rather than balloon is safe and effective for treating coronary artery perforation, it may be not the best choice overall. If the perforation breaks through into the right ventricle, we may just monitor closely rather than treat. That course may be beneficial for patients in that it reduces the risk of myocardial cell necrosis. This case provides useful information for the treatment of such patients in the future.
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Affiliation(s)
- Guoqiang Gu
- Department of Cardiology, Hebei Institute of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jidong Zhang
- Department of Cardiology, Hebei Institute of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Cui
- Department of Cardiology, Hebei Institute of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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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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Yıldız A, Karakurt A, Bitigen A, Bağırtan B. Fatal complication, rescue therapy; covered stent for coronary artery perforation. Health (London) 2013. [DOI: 10.4236/health.2013.57a3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Caixeta A, Nikolsky E, Lansky AJ, Mehran R, Dangas GD. Coronary Artery Dissection and Perforation. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ben-Gal Y, Weisz G, Collins MB, Genereux P, Dangas GD, Teirstein PS, Singh VP, Rabbani LE, Kodali SK, Sherman W, Leon MB, Moses JW. Dual catheter technique for the treatment of severe coronary artery perforations. Catheter Cardiovasc Interv 2010; 75:708-12. [PMID: 20049957 DOI: 10.1002/ccd.22331] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the outcome of patients with coronary perforations who were treated with the dual catheter approach. BACKGROUND Coronary artery perforation is a grave complication of percutaneous coronary intervention (PCI) with high mortality and morbidity. Treating a coronary artery perforation with two catheters through dual access enables a rapid delivery of covered stent or coils to the vessel, without losing control of the perforation site. METHODS We retrospectively reviewed all patients who had a severe coronary perforation during a PCI in our center, and compared outcomes of patients treated with the dual versus the traditional single guiding catheter approach. RESULTS Between April 2004 and October 2008, 13,466 PCI's were performed in Columbia University - New York Presbyterian Medical Center. There were 33 documented cases of coronary perforations during that period of time (0.245%), among these, 26 were angiographically severe (Ellis type 2 or 3 perforations). Eleven patients were treated acutely with a dual catheter technique whereas the other fifteen patients were treated using a single guiding catheter. In the dual catheter group one patient expired after emergent CABG (9.1%), and four patients underwent emergent paricardiocentesis (36.4%). In patients treated with single catheter, there were three deaths (20%), two surgical explorations (13.3%), eight emergent pericardiocenthesis (53.3%), and one event of severe anoxic brain damage (6.7%). CONCLUSION The dual catheter technique is a relatively safe and reproducible approach to treat a PCI induced severe coronary artery perforation, and may improve outcome compared to historical series.
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Affiliation(s)
- Yanai Ben-Gal
- Interventional Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York 10032, USA.
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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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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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Yeo KK, Rogers JH, Laird JR. Use of stent grafts and coils in vessel rupture and perforation. J Interv Cardiol 2008; 21:86-99. [PMID: 18254790 DOI: 10.1111/j.1540-8183.2007.00302.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vessel rupture and perforation are important complications of percutaneous treatment of coronary and peripheral arterial disease. These complications can result in abrupt vessel closure, distal organ injury, bleeding into the surrounding tissue, and death. Prompt management of such complications is therefore critically important. This paper reviews the management of vessel rupture and perforation, including the use of different types of covered stents (balloon-expandable and self-expanding), as well as the various types of embolization coils. Particular focus will be placed on percutaneous coronary artery and peripheral arterial interventions.
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Affiliation(s)
- Khung Keong Yeo
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
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Tajima H, Murata S, Kumazaki T, Abe Y, Takano T. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization. Cardiovasc Intervent Radiol 2005; 29:155-6. [PMID: 15983859 DOI: 10.1007/s00270-003-0172-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A distal pulmonary artery perforation was successfully occluded by percutaneous microcoil embolization via a microcatheter. Microcoil embolization is a reasonable alternative therapeutic approach for this rare complication of pulmonary interventional procedures.
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Affiliation(s)
- Hiroyuki Tajima
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Bunkyo-ku, Tokyo 113-8602, Japan.
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Eggebrecht H, Ritzel A, von Birgelen C, Schermund A, Naber C, Böse D, Baumgart D, Bartel T, Haude M, Erbel R. Acute and long-term outcome after coronary artery perforation during percutaneous coronary interventions. ACTA ACUST UNITED AC 2004; 93:791-8. [PMID: 15492894 DOI: 10.1007/s00392-004-0123-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 05/14/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions (PCI). METHODS We reviewed our database for cases of overt coronary perforation during PCI procedures. Hospital charts, procedural reports, and coronary angiograms of these patients were reviewed, with particular emphasis on mechanisms of perforation, management of the complication, and clinical outcome. RESULTS Between 01/1998 and 12/2003, a total of 19 cases (mean age: 66+/-8 years, 13 male) of coronary perforation occurred during 6433 PCI procedures performed within this period (incidence: 0.3%). In 12/19 (63%) cases, perforation occurred during recanalisation procedures of chronic total occlusions of coronary arteries. In all but one patient, non-surgical management was attempted: 2 out of 19 (11%) patients were treated conservatively by reversal of heparin anticoagulation. Prolonged balloon inflation at the perforation site was applied in 10/19 (53%) patients. Six (32%) patients received stents (5 of them received covered stentgrafts), 3 (16%) patients developed cardiac tamponade requiring percardiocentesis, and only 2 (11%) patients underwent bailout surgical repair. There were 2 (11%) deaths early after the procedure. CONCLUSION Coronary perforation during PCI is a rare complication, but is associated with significant morbidity and mortality. In the majority of patients, non-surgical management is both feasible and associated with a high success-rate.
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Affiliation(s)
- H Eggebrecht
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Fasseas P, Orford JL, Panetta CJ, Bell MR, Denktas AE, Lennon RJ, Holmes DR, Berger PB. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J 2004; 147:140-5. [PMID: 14691432 DOI: 10.1016/s0002-8703(03)00505-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary perforation is a serious but uncommon complication of percutaneous coronary intervention (PCI) and is associated with significant morbidity and mortality. METHODS We performed an analysis of the Mayo Clinic PCI database. Clinical records, procedural reports, and angiographic studies were reviewed. Multiple logistic regression analysis was performed to identify clinical, procedural, anatomic, and angiographic correlates of coronary perforation. RESULTS A total of 16,298 PCI procedures were performed between January 1990 and December 2001. We identified 95 coronary perforations (0.58%; 95% CI, 0.47-0.71). The incidence of coronary perforation varied with time. Correlates of coronary perforation included the use of an atheroablative device and female sex. Twelve patients (12.6%) sustained an acute myocardial infarction, and cardiac tamponade developed in 11 patients (11.6%). Management strategies included reversal of heparin, pericardiocentesis, placement of a covered stent, and surgical repair. Seven patients died (7.4%). CONCLUSIONS Coronary perforation during PCI is rare, but is associated with significant morbidity and mortality. The variable frequency of perforation may be explained by temporal variations in the use of atheroablative devices.
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Affiliation(s)
- Panayotis Fasseas
- Division of Cardiovascular Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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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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