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Wu EB, Kalyanasundaram A, Brilakis ES, Mashayekhi K, Tsuchikane E. Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions. Heart Lung Circ 2024; 33:915-931. [PMID: 38839467 DOI: 10.1016/j.hlc.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 06/07/2024]
Abstract
Safety is of critical importance to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This global consensus statement provides guidance on how to optimise the safety of CTO) PCI, addressing the following 12 areas: 1. Set-up for safe CTO PCI; 2. Guide catheter--associated vessel injuries; 3. Hydraulic dissection, extraplaque haematoma expansion, and aortic dissections; 4. Haemodynamic collapse during CTO PCI; 5. Side branch occlusion; 6. Perforations; 7. Equipment entrapment; 8. Vascular access considerations; 9. Contrast-induced acute kidney injury; 10. Radiation injury; 11 When to stop; and, 12. Proctorship. This statement complements the global CTO crossing algorithm; by advising how to prevent and deal with complications, this statement aims to facilitate clinical practice, research, and education relating to CTO PCI.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center, Freiburg Bad Krozingen, Germany
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2
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Sucharski M, Kurpaska M, Malinowski M, Krzesiński P. New Techniques in Iatrogenic Coronary Artery Perforation Management Including Umbrella Technique, Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S245-S249. [PMID: 37198065 DOI: 10.1016/j.carrev.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
This case report presents a patient with iatrogenic coronary artery perforation during coronary angioplasty, complicated with a life-threatening cardiac tamponade. Tamponade decompression was achieved via timely pericardiocentesis with direct autotransfusion. The coronary artery perforation itself was initially closed by using the umbrella technique, which involves distal vessel occlusion with angioplasty balloon fragments. To control further blood extravasation into the pericardial sac, the perforation site was injected with thrombin, ensuring the leak closure. If performed with caution, these relatively rarely used, management techniques are effective in dealing with percutaneous coronary intervention complications.
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Affiliation(s)
- Mateusz Sucharski
- Department of Cardiology and Internal Medicine, Military Institute of Medicine, National Research Institute, ul. Szaserów 128, 04-141 Warsaw, Poland.
| | - Małgorzata Kurpaska
- Department of Cardiology and Internal Medicine, Military Institute of Medicine, National Research Institute, ul. Szaserów 128, 04-141 Warsaw, Poland.
| | - Michał Malinowski
- Department of Cardiology and Internal Medicine, Military Institute of Medicine, National Research Institute, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Medicine, Military Institute of Medicine, National Research Institute, ul. Szaserów 128, 04-141 Warsaw, Poland
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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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Management of Coronary Artery Perforation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:55-60. [PMID: 33203580 DOI: 10.1016/j.carrev.2020.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors for CAP include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. There are 3 major types of CAP depending on location: (a) large vessel perforation, (b) distal vessel perforation, and (c) collateral perforation. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with coil or fat embolization. In this article we provide a state-of-the-art overview of the contemporary management of CAP.
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Krishnegowda C, Puttegowda B, Krishnappa S, Ananthakrishna R, Mahadevappa NC, Siddegowda SK, Ramegowda RT, Manjunath CN. "Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention". Indian Heart J 2020; 72:232-238. [PMID: 32861375 PMCID: PMC7474113 DOI: 10.1016/j.ihj.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/31/2023] Open
Abstract
AIMS To study the incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) at a high volume center in South-east Asia. METHODS Data from patients who had CAP during PCI from January 2016 to December 2019 at our center were collected. Clinical features, angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively. RESULTS A total of 40,696 patients underwent PCI during the study period and the incidence of CAP was 0.13% (n = 51). Mean age was 60.0 ± 10.8 years and 69% were males. CAP cases involved complex type B2/C lesions in 73%, calcified lesions in 58%, and chronic total occlusions in 25%. Majority of patients presented as acute coronary syndrome (65%) and STEMI was the most frequent indication for PCI (33%). Most of the CAPs were Ellis type II (33%) and III (55%). CAP most frequently occurred during post dilation (n = 20) and wire manipulation (n = 17). Majority were treated by prolonged balloon inflation (53%) and covered stents (33%). Pericardiocentesis was required in 19 patients to alleviate tamponade. In one patient coil embolisation was done and two patients required bail-out emergency cardiac surgery. Periprocedural myocardial infarction occurred in 6% and in-hospital mortality was 10%. All-cause mortality accrued to 14% at 30 days and 16% at 6 months. CONCLUSION Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.
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Affiliation(s)
- Chetana Krishnegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India.
| | - Beeresha Puttegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Nagesh C Mahadevappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Sadananda K Siddegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India
| | - Raghu T Ramegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Cholenahally N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Fiorelli A, Messina G, Santoriello C, Liguori G, Arrigo E, Caronia FP, Santini M. Fibrin glue to fix metallic airway stent. J Thorac Dis 2019; 11:E4-E7. [PMID: 30863614 DOI: 10.21037/jtd.2018.12.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giovanni Liguori
- Anaestesia and Intensive care Unit, Cardarelli Hospital, Naples, Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande (CT), Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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Tajti P, Xenogiannis I, Chavez I, Gössl M, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Burke MN, Brilakis ES. Expecting the unexpected: preventing and managing the consequences of coronary perforations. Expert Rev Cardiovasc Ther 2018; 16:805-814. [DOI: 10.1080/14779072.2018.1533402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Shaukat A, Tajti P, Sandoval Y, Stanberry L, Garberich R, Nicholas Burke M, Gössl M, Henry T, Mooney M, Sorajja P, Traverse J, Bradley SM, Brilakis ES. Incidence, predictors, management and outcomes of coronary perforations. Catheter Cardiovasc Interv 2018; 93:48-56. [PMID: 30312992 DOI: 10.1002/ccd.27706] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. BACKGROUND Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. METHODS Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk-adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One-year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. RESULTS Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22-13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in-hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. CONCLUSIONS Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in-hospital mortality, highlighting the importance of prevention.
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Affiliation(s)
- Arslan Shaukat
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Larissa Stanberry
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Ross Garberich
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Timothy Henry
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Cedars Sinai Medical Center, Los Angeles, California
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Steven M Bradley
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Lemmert ME, van Bommel RJ, Diletti R, Wilschut JM, de Jaegere PP, Zijlstra F, Daemen J, Van Mieghem NM. Clinical Characteristics and Management of Coronary Artery Perforations: A Single-Center 11-Year Experience and Practical Overview. J Am Heart Assoc 2017; 6:JAHA.117.007049. [PMID: 28939719 PMCID: PMC5634316 DOI: 10.1161/jaha.117.007049] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Coronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11‐year single‐center experience. Methods and Results From February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62.7% were male. Treated lesion type was B2/C in 94.6%, and 31.3% were chronic total occlusions. Nonworkhorse guidewires were applied in 74.3%. CAP types were Ellis type I in 2.9%, Ellis type II in 40.4%, Ellis type III in 54.8%, and Ellis type III cavity spilling in 1.9%. CAP treatment was conservative (including prolonged balloon inflation) in 73.3%. Covered stents, coiling, and fat embolization were used in 24.0%, 0.7%, and 2.0%, respectively. Pericardiocentesis for tamponade was required for 72 patients (48.0%), of whom 28 were initially unrecognized. Twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. Periprocedural myocardial infarction occurred in 34.0%, and in‐hospital all‐cause mortality was 8.0%. All‐cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year. Conclusions CAP is a rare complication of percutaneous coronary intervention, but morbidity and mortality are considerable. Early recognition and adequate management are of paramount importance.
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Affiliation(s)
| | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | - F Zijlstra
- Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
| | - Joost Daemen
- Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
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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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Ricci DR, Marotta TR, Riina HA, Wan M, De Vries J. A training paradigm to enhance performance and safe use of an innovative neuroendovascular device. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2016; 4:33248. [PMID: 27867466 PMCID: PMC5105320 DOI: 10.3402/jmahp.v4.33248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
Training has been important to facilitate the safe use of new devices designed to repair vascular structures. This paper outlines the generic elements of a training program for vascular devices and uses as an example the actual training requirements for a novel device developed for the treatment of bifurcation intracranial aneurysms. Critical elements of the program include awareness of the clinical problem, technical features of device, case selection, and use of a simulator. Formal proctoring, evaluation of the training, and recording the clinical outcomes complement these elements. Interventional physicians should embrace the merits of a training module to improve the user experience, and vendors, physicians, and patients alike should be aligned in the goal of device training to improve its success rate and minimize complications of the procedure.
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Affiliation(s)
- Donald R. Ricci
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
- Evasc Medical Systems Corporation, Vancouver, BC, Canada
| | - Thomas R. Marotta
- Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Howard A. Riina
- Department of Neurosurgery, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Martina Wan
- Evasc Medical Systems Corporation, Vancouver, BC, Canada
| | - Joost De Vries
- Department of Neurosurgery, Radboud University Nijmegen, Nijmegen, The Netherlands
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Kalyanasundaram A, Lombardi WL. COMPLICATIONS OF RECANALIZATION OF CHRONIC TOTAL OCCLUSION. Curr Cardiol Rev 2015; 11:305-313. [PMID: 26354515 PMCID: PMC4774634 DOI: 10.2174/1573403x11666150909105725] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022] Open
Abstract
Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusions (CTO) is an accepted revascularization procedure. These complex procedures carry with them certain risks and potential complications. Complications of PCI such as contrast induced renal dysfunction, radiation, etc, assume more relevance given the length and complexity of these procedures. Further, certain complications such as donor vessel injury, foreign body entrapment are unique to CTO PCI. A thorough understanding of the potential complications is important in mitigating risk during these complex procedures.
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Affiliation(s)
- Arun Kalyanasundaram
- Seattle Heart and Vascular Institute 16259 Sylvester Rd SW #401, Burien, WA 98166 USA
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Politi L, Iaccarino D, Sangiorgi GM, Modena MG. Huge coronary perforation during percutaneous intervention sealed by injection of polyvinyl alcohol microspheres. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 2:S130-2. [PMID: 21119525 DOI: 10.2459/jcm.0b013e328341d08f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During percutaneous coronary intervention, coronary perforation is one of the most feared life-threatening complications, as it may cause cardiac tamponade or acute myocardial infarction. The incidence of this serious complication in recent years has increased from 0.2 to 0.6%, most likely due to the increase of complex procedures. However, the management of coronary perforation has not been established yet. We report the first case of coronary perforation successfully managed with intracoronary injection of hydrogel microspheres.
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Affiliation(s)
- Luigi Politi
- Cardiology Department, Policlinico University Hospital, Modena, Italy
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14
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Dimitrakakis G, Von Oppell UO, Balachandran S, Pericleous A, Anderson R. Coronary Artery Perforation following PCI: An Interesting Finding into the Pericardial Space. Int J Angiol 2014; 22:239-42. [PMID: 24436619 DOI: 10.1055/s-0033-1343359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Coronary artery perforation is a known complication of percutaneous coronary intervention and potentially life threatening. Normally, these perforations are small and localized. We report the successful surgical management of a coronary artery perforation following stent insertion with extrusion of an 8-cm endarterectomy length of the circumflex coronary artery with a brief review of the recent literature.
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Affiliation(s)
- Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Ulrich Otto Von Oppell
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | | | - Agamemnon Pericleous
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
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Kuon E, Murad S. Coronary guidewire perforation into the left ventricular cavity: A rare complication of coronary angioplasty. Herz 2013; 40 Suppl 1:59-60. [PMID: 24297402 DOI: 10.1007/s00059-013-4014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/05/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Affiliation(s)
- E Kuon
- Department of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany,
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16
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Patel Y, Depta JP, DeMartini TJ. Complications of chronic total occlusion percutaneous coronary intervention. Interv Cardiol 2013. [DOI: 10.2217/ica.13.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Treatment of collateral channel perforation during percutaneous coronary intervention for chronic total occlusion with retrograde approach. Cardiovasc Interv Ther 2013; 29:86-92. [DOI: 10.1007/s12928-013-0198-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
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Al-Mukhaini M, Panduranga P, Sulaiman K, Riyami AA, Deeb M, Riyami MB. Coronary perforation and covered stents: an update and review. Heart Views 2012; 12:63-70. [PMID: 22121463 PMCID: PMC3221194 DOI: 10.4103/1995-705x.86017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater), II (myocardial or pericardial blushing), and III (contrast streaming or cavity spilling). Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention.
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Willaert W, Van Herzeele I, Ceelen W, Van De Putte D, Vermassen F, Pattyn P. Endovascular treatment of an iatrogenic perforation of the internal iliac vein. Ann Vasc Surg 2012; 26:733.e1-4. [PMID: 22664295 DOI: 10.1016/j.avsg.2011.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/28/2022]
Abstract
We describe the case of a 48-year-old woman who developed a pelvic abscess after extensive surgery for recurrent ovarian cancer. While draining the abscess, a massive venous bleeding occurred. The bleeding was controlled by introducing a Foley catheter transrectally, occluding the perforated internal iliac vein. However, the catheter was positioned unintentionally in the inferior vena cava, causing hemodynamic instability. The iatrogenic perforation of the internal iliac vein was managed successfully with an endovascular approach using thrombin in combination with balloon-induced thrombosis. If iatrogenic venous bleeding occurs and the placement of a stent is precluded, balloon-induced thrombosis in combination with thrombin injection can be used successfully.
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Affiliation(s)
- Wouter Willaert
- Department of Surgery, Ghent University Hospital, Ghent, Belgium.
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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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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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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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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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Godino C, Sharp ASP, Carlino M, Colombo A. Crossing CTOsâThe tips, tricks, and specialist Kit that can mean the difference between success and failure. Catheter Cardiovasc Interv 2009; 74:1019-46. [PMID: 19950136 DOI: 10.1002/ccd.22161] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/methods
- Chronic Disease
- Clinical Competence
- Coronary Occlusion/pathology
- Coronary Occlusion/therapy
- Coronary Vessels/injuries
- Equipment Design
- Heart Injuries/etiology
- Heart Injuries/prevention & control
- Humans
- Patient Selection
- Prosthesis Design
- Radiography, Interventional
- Rupture
- Stents
- Treatment Failure
- Treatment Outcome
- Ultrasonography, Interventional
- Wounds, Penetrating/etiology
- Wounds, Penetrating/prevention & control
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Affiliation(s)
- Cosmo Godino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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Wilsmore B, Gunalingam B. Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management. J Interv Cardiol 2009; 22:460-5. [PMID: 19732283 DOI: 10.1111/j.1540-8183.2009.00496.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
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Affiliation(s)
- Bradley Wilsmore
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
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Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era. JACC Cardiovasc Interv 2009; 2:705-17. [DOI: 10.1016/j.jcin.2009.04.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/03/2009] [Indexed: 11/20/2022]
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Goel PK. Delayed and repeated cardiac tamponade following microleak in RCA successfully treated with intra arterial sterile glue injection. Catheter Cardiovasc Interv 2009; 73:797-800. [DOI: 10.1002/ccd.21924] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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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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