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Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:412-7. [DOI: 10.1016/j.carrev.2016.05.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
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Chowdhury MA, Sheikh MA. Coronary bypass graft perforation during percutaneous intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 17:48-53. [PMID: 26831902 DOI: 10.1016/j.carrev.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/06/2015] [Accepted: 11/19/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Coronary artery bypass grafts are prone to accelerated atherosclerosis and as such graft stenosis is frequently encountered in clinical practice. Complications specific to graft- PCI include no-reflow, distal embolization, stent restenosis and thrombosis. Graft perforation during PCI is a rare coomplication of the procedure. Published literature on the predictors of perforation and management strategy remains limited to anecdotal cases. METHOD In this review we collected data on all cases of graft perforations reported in PubMed/Medline from 1987 to 2015. RESULT 37 cases of graft perforation were reported. High risk grafts for perforations included, old grafts (14±7.8years) with more than 80% luminal stenosis. Perforations were noted after use of different cardiac devices and included stent placement (30%, N=11), balloon angioplasty (36%, N=14), post-dilation with non complaint balloon (16%, N=6), guide wire perforation (1 case), post IVUS imaging (1 case) and one case after use of thrombus extraction device. Average stent diameter of 3.7±0.7 mm, average balloon pressure of 15.5±5 atm and 3 or more balloon inflations commonly resulted in graft perforation. 78% of cases reported class III perforation. Covered stent implantation was strongly associated with controlling acute bleed after graft perforation than prolonged balloon inflation (p=0.0001). Majority of cases reported using covered stents (81%). Average stent diameter of 3.9±0.7mm, average stent length of 18.5±6mm and the average deployment pressure of 14±2atm were reported to be effective in controlling the bleed. 95% of the patients did well post procedure and with prolonged hospitalization (8±4days). 24% of cases reported cardiac tamponade causing hemodynamic compromise including 2 peri-procedural deaths. CONCLUSION Graft perforation can be effectively treated with covered stent grafts with good immediate results, short term outcome and acceptable peri-procedural risks.
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Shreenivas S, Anwaruddin S. Management of Complications During Saphenous Vein Graft Interventions. Interv Cardiol Clin 2013; 2:339-346. [PMID: 28582140 DOI: 10.1016/j.iccl.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Because of greater patient comorbidities, more diffusely diseased vessels, and the greater possibility of mechanical complications, saphenous vein graft interventions are fraught with complications. The greatest risk is a higher risk of periprocedural myocardial infarction due to distal embolization of microemboli. The risk for noreflow in a patient with concomitant native critical vessel disease can have grave consequences. Minimizing the risk of periprocedural myocardial infarction with the use of distal embolic protection, understanding the role of adjunctive pharmacotherapy, and learning how to manage less common but serious mechanical complications during saphenous vein graft interventions are important to ensure optimal patient outcomes.
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Affiliation(s)
- Satya Shreenivas
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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4
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El Hosieny A, Hui W. Fistula between right coronary artery vein graft and right atrium as an immediate complication of percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 80:71-4. [PMID: 22234898 DOI: 10.1002/ccd.23371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/25/2011] [Indexed: 11/09/2022]
Abstract
Fistula between saphenous vein graft (SVG) and a cardiac chamber or structure is a rare complication after coronary artery bypass grafting (CABG). We report the first case of a fistula between SVG and the right atrium (RA) as an immediate complication after a percutaneous coronary intervention (PCI) in an 86-year-old female. She presented with inferior ST-elevation myocardial infarction (STEMI) and was treated with thrombolytic therapy in a peripheral hospital, which was unsuccessful. PCI to SVG to the right coronary (RCA) was complicated by a fistula to RA. Cardiac magnetic resonance (CMR) confirmed the site of the fistula and also presence of a significant arteriovenous (AV) shunt. Reversal of anticoagulation had no effect on fistula closure. Therefore, a covered stent was deployed for closure of the fistula to avoid long-term complications of the significant AV shunt. In summary, the diagnosis and appropriate management of this rare complication is challenging, but excellent result can be achieved by the use of appropriate percutaneous techniques.
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Affiliation(s)
- Adel El Hosieny
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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5
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Baruah D. Covered stent to treat saphenous venous graft perforation-A case report. Catheter Cardiovasc Interv 2010; 76:844-6. [DOI: 10.1002/ccd.22401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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6
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Han HJ, Choi JO, Sohn GH, Byeon KM, Kim YJ, Choi JH, Park SW. A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention. J Cardiovasc Ultrasound 2008. [DOI: 10.4250/jcu.2008.16.4.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hye Jin Han
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gwan Hyeop Sohn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Min Byeon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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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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8
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Kawase Y, Hayase M, Ito S, Ojio S, Tahara H, Ehara M, Kondo H, Ito Y, Suzuki Y, Ishihara Y, Suzuki T. Compression of right ventricular out-flow due to localized hematoma after coronary perforation during PCI. Catheter Cardiovasc Interv 2003; 58:202-6. [PMID: 12552545 DOI: 10.1002/ccd.10443] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although coronary perforation can cause tamponade during percutaneous coronary intervention (PCI), this is unusual for patients previously undergoing coronary artery bypass graft surgery (CABG) due to pericardial adhesions. We report here on a rare case of right ventricular out-flow obstruction complicating PCI in a patient with a previous CABG.
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Affiliation(s)
- Yoshiaki Kawase
- Division of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan.
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9
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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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10
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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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11
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Kihara S, Shimakura T, Tanaka SA, Saito N, Sugawara Y. Surgical angioplasty of ruptured left anterior descending coronary artery without cardiopulmonary bypass. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:326-8. [PMID: 10860290 DOI: 10.1007/bf03218150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of successful off-pump surgical angioplasty in the left anterior descending coronary artery using a saphenous vein patch. A 49-year-old male with left main disease and severe cerebrovascular stenosis underwent off-pump bypass to the left anterior descending artery. Postoperative angiography showed anastomotic stenosis where balloon angioplasty was performed. However, it resulted in coronary perforation complicated with epicardial tamponade, and emergency off-pump surgical angioplasty was performed. This case demonstrated that coronary arterial rupture could be managed by surgical angioplasty without cardiopulmonary bypass when coronary artery perforation occurred.
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Affiliation(s)
- S Kihara
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Hiroshima, Japan
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12
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Caputo RP, Amin N, Marvasti M, Wagner S, Levy C, Giambartolomei A. Successful treatment of a saphenous vein graft perforation with an autologous vein-covered stent. Catheter Cardiovasc Interv 1999; 48:382-6. [PMID: 10559819 DOI: 10.1002/(sici)1522-726x(199912)48:4<382::aid-ccd12>3.0.co;2-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 52-year-old man with a history of prior coronary bypass surgery suffered recurrent angina and underwent percutaneous placement of a stent within the midportion of the saphenous vein graft to the marginal branch of the left circumflex coronary artery, which was complicated by a significant perforation. The perforation was successfully closed using an NIR stent covered with a segment of autologous antecubital vein. Subsequent surgical exploration confirmed successful closure of the perforation. Cathet. Cardiovasc. Intervent. 48:382-386, 1999.
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Affiliation(s)
- R P Caputo
- St. Joseph's Hospital, Syracuse, New York 13203, USA
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Schöbel WA, Voelker W, Haase KK, Karsch KR. Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. Catheter Cardiovasc Interv 1999; 47:341-6. [PMID: 10402295 DOI: 10.1002/(sici)1522-726x(199907)47:3<341::aid-ccd22>3.0.co;2-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.
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Affiliation(s)
- W A Schöbel
- Department of Cardiology, University of Tübingen, Tübingen, Germany.
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Dardas PS, Tsikaderis DD, Makrigiannakis K, Saripoulos P, Toumbouras M. Complete left atrial obliteration due to localized tamponade after coronary artery perforation during PTCA. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:61-3. [PMID: 9736355 DOI: 10.1002/(sici)1097-0304(199809)45:1<61::aid-ccd14>3.0.co;2-o] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery perforation is a rare but important complication of percutaneous revascularization (PTCA). Clinical events following coronary perforation may include cardiac tamponade. After bypass graft operation (CABG), however, cardiac tamponade with subsequent hemodynamic instability is unusual due to the development of pericardial adhesions. We report an unusual case of localized tamponade after coronary artery perforation during PTCA in a patient with previous CABG.
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Affiliation(s)
- P S Dardas
- Department of Cardiology and Cardiac Surgery, Geniki Kliniki, Thessaloniki, Greece
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15
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Dorros G, Jain A, Kumar K. Management of coronary artery rupture: covered stent or microcoil embolization. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:148-54; discussion 155. [PMID: 8829837 DOI: 10.1002/ccd.1810360213] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The management of three cases of coronary artery rupture is described: (1) after high-pressure balloon angioplasty following uneventful placement of three Gianturco-Roubin stents, (2) following balloon angioplasty of an occluded diagonal branch, and (3) subsequent to rotational ablation of a left main and proximal circumflex arteries. Placement of an autologous vein-covered Palmaz stent or microcoil embolic vessel occlusion solved each problem. In each case, emergency surgery was avoided; subsequent management, including anticoagulation (when indicated), was performed without incident. This is the first communication detailing correction of a coronary vessel rupture with an autologous vein-covered stent or by microcoil embolic vessel occlusion.
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Affiliation(s)
- G Dorros
- William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., Milwaukee, WI 53215-3660, USA
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16
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Wong SC, Baim DS, Schatz RA, Teirstein PS, King SB, Curry RC, Heuser RR, Ellis SG, Cleman MW, Overlie P. Immediate results and late outcomes after stent implantation in saphenous vein graft lesions: the multicenter U.S. Palmaz-Schatz stent experience. The Palmaz-Schatz Stent Study Group. J Am Coll Cardiol 1995; 26:704-12. [PMID: 7642863 DOI: 10.1016/0735-1097(95)00217-r] [Citation(s) in RCA: 133] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study reports the multicenter registry experience evaluating the safety and efficacy of the Palmaz-Schatz stent in the treatment of saphenous vein graft disease. BACKGROUND Saphenous vein graft angioplasty is associated with frequent periprocedural complications and a high frequency of restenosis. Stent implantation has been shown to reduce restenosis, with improved long-term outcomes in the treatment of native coronary artery disease. Preliminary experience with stent placement in the treatment of saphenous vein graft lesions has been favorable. METHODS Twenty U.S. investigator sites enrolled a total of 589 symptomatic patients (624 lesions) for treatment of focal vein graft stenoses between January 1990 and April 1992. Follow-up angiography was performed at 6 months, and the clinical course of all study patients was prospectively collected at regular intervals for up to 12 months. RESULTS Stent delivery was successful in 98.8% of cases, and the procedural success rate was 97.1%. The lesion diameter stenosis decreased from 82 +/- 12% (mean +/- SD) before to 6.6 +/- 10.2% after treatment. Major in-hospital complications occurred in 17 patients (2.9%); stent thrombosis was found in 8 (1.4%); and major vascular or bleeding complications were noted in 83 (14.3%). Six-month angiographic follow-up revealed an overall restenosis rate (> or = 50% diameter stenosis) of 29.7%. Multivariate logistic regression analysis indicated that 1) restenotic lesions, 2) smaller reference vessel size, 3) history of diabetes mellitus, and 4) higher percent poststent diameter stenosis were independent predictors of restenosis. The 12-month actuarial event-free survival was 76.3%. CONCLUSIONS Stent implantation in patients with focal saphenous vein graft lesions can be achieved with a high rate of procedural success, acceptable major complications, reduced angiographic restenosis and favorable late clinical outcome compared with historical balloon angioplasty control series. The rigorous anticoagulation regimen after stent placement results in more frequent vascular and other bleeding complications. Future randomized studies comparing standard balloon angioplasty with stent implantation are warranted to properly assess the full impact of stent placement in the treatment of saphenous vein graft lesions.
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Affiliation(s)
- S C Wong
- Department of Internal Medicine (Division of Cardiology), Washington Hospital Center, Washington, D.C. 20010, USA
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Wong SC, Popma JJ, Pichard AD, Kent KM, Satler LF, Mintz GS, Chuang YC, Hong MK, Ditrano CJ, Leon MB. Comparison of clinical and angiographic outcomes after saphenous vein graft angioplasty using coronary versus 'biliary' tubular slotted stents. Circulation 1995; 91:339-50. [PMID: 7805236 DOI: 10.1161/01.cir.91.2.339] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Saphenous vein graft (SVG) angioplasty using 15-mm articulated, tubular slotted stents results in low (0% to 20%) residual diameter stenoses and infrequent (< 5%) major complications. A "biliary" stent design with greater radial compressive strength, enhanced visibility, and more variable sizing (diameter and length) has been approved for noncoronary indications. A comparison of outcomes after coronary versus biliary stent placement in SVG stenoses has not been performed. The purpose of this study was to compare the angiographic and clinical results after SVG angioplasty using these two balloon-expandable, tubular slotted stent designs. METHODS AND RESULTS During a 3-year period, 231 patients with 305 SVG lesions were treated using Palmaz-Schatz coronary (n = 108) or biliary (n = 123) stents. Cineangiograms were reviewed using qualitative morphological and quantitative angiographic methods. Time-dependent clinical outcome (freedom from death, Q-wave myocardial infarction, or the need for repeat coronary bypass surgery or SVG angioplasty) was assessed using Kaplan-Meier life-table methods. Unstable angina (P < .001) and recent myocardial infarction (P = .001) were present more often in patients undergoing biliary stent versus coronary stent placement. Biliary stent-treated SVG lesions were more frequently de novo (P = .001), ostial in location (P = .002), > or = 10 mm in length (P = .009), thrombus containing (P = .001), and ulcerated (P < .001) than coronary stent-treated SVG lesions. Angiographically, biliary stent-treated lesions had larger reference vessel diameter (3.43 +/- 0.59 mm versus 3.10 +/- 0.64 mm, P < .001), higher balloon-to-artery ratio (1.15 +/- 0.16 mm versus 1.07 +/- 0.19, P = .0001), and lower residual diameter stenosis (6 +/- 17% versus 14 +/- 11% in coronary stent-treated patients; P < .001). Procedural success rates were high (95%), in-hospital major complications were uncommon (< 3%), and follow-up clinical outcomes were favorable (6-month event-free survival approximately 80%) in both groups. CONCLUSIONS Despite frequent short-term ischemic syndromes and unfavorable lesion characteristics, both biliary and coronary cohorts have similarly favorable short-term procedural results and long-term clinical outcomes. The increased strut thickness of the biliary stent confers greater fluoroscopic visibility and radial compressive strength in exchange for decreased stent flexibility and added technical demand in stent deployment. Extreme caution is recommended with biliary stent placement in the treatment of SVG lesions as clinical results are highly operator dependent.
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Affiliation(s)
- S C Wong
- Department of Internal Medicine (Division of Cardiology), Washington Hospital Center, Washington, DC 20010
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18
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Wong SC, Popma JJ, Kent KM, Pichard AD, Satler LF, Mintz GS, Leon MB. Clinical experience with stent implantation in the treatment of saphenous vein graft lesions. J Interv Cardiol 1994; 7:565-73. [PMID: 10155205 DOI: 10.1111/j.1540-8183.1994.tb00497.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- S C Wong
- Department of Internal Medicine, Washington Hospital Center, D.C. 20010, USA
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Ajluni SC, Glazier S, Blankenship L, O'Neill WW, Safian RD. Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:206-12. [PMID: 7954767 DOI: 10.1002/ccd.1810320303] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronary perforation is a rare, but potentially catastrophic, complication of percutaneous coronary intervention. A retrospective review of the Cardiology Quality Assurance Database was performed for all percutaneous coronary interventions (n = 8,932) at William Beaumont Hospital from October 1988 to December 1992. Coronary artery perforation was reported in 35 patients (0.4%), including after percutaneous transluminal coronary angioplasty (PTCA, 11/7,905, 0.14%), transluminal extraction coronary atherectomy (TEC, 6/420, 1.3%), directional coronary atherectomy (DCA, 1/249, 0.25%), and excimer laser coronary angioplasty (ELCA, 5/242, 2%); and none after high-speed mechanical rotational atherectomy with the Rotablator (MRA, 0/116, 0%). Perforations were classified by coronary angiography as free perforations (n = 10), contained perforations (n = 17), or other types of perforation (n = 8). Although perforation was apparent in 32 (91%) of 35 angiograms, delayed cardiac tamponade occurred in 3 patients (9%), despite the absence of angiographic evidence for perforation at the time of the procedure. Causes of perforation were the guidewire in 7 (20%), an interventional device in 26 (74%), and indeterminate in 2 (6%). Complex B2 or C lesions accounted for 83% of perforations. Final treatment included conservative therapy (reversal of anticoagulation and/or PTCA) in 22 (63%) and surgical intervention (with or without bypass surgery) in 13 (37%). Serious clinical complications included cardiac tamponade in 6 (17%), blood transfusion in 12 (34%), myocardial infarction in 9 (26%), and death in 3 (9%).
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Affiliation(s)
- S C Ajluni
- Division of Cardiology (Department of Medicine), William Beaumont Hospital, Royal Oak, Michigan 48073-6769
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Bittl JA, Ryan TJ, Keaney JF, Tcheng JE, Ellis SG, Isner JM, Sanborn TA. Coronary artery perforation during excimer laser coronary angioplasty. The percutaneous Excimer Laser Coronary Angioplasty Registry. J Am Coll Cardiol 1993; 21:1158-65. [PMID: 8459071 DOI: 10.1016/0735-1097(93)90240-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the risk of vessel perforation during excimer laser angioplasty. BACKGROUND Vessel perforation is a serious complication of angioplasty. METHODS A total of 764 patients had 858 stenoses treated with excimer laser angioplasty. Laser catheters had a diameter of 1.4, 1.7 or 2 mm. Laser energy was delivered in pulses of 135 ns, at a frequency of 25 s-1 and at a fluence of 30 to 60 mJ/mm2. Follow-up angiography was requested for all patients who did not require emergency bypass surgery. RESULTS In the 764 consecutive patients treated with excimer laser coronary angioplasty, vessel perforation occurred in 23 patients (3%). Nine patients had a major complication resulting directly from vessel perforation (cardiac tamponade, myocardial infarction or need for bypass surgery) and 14 had no clinical complications after successful sealing of the puncture site. No patient with a perforation died. Multivariate analysis showed that bifurcation lesions (odds ratio [OR] = 3.5; p = 0.049), diabetes mellitus (OR = 3.15; p = 0.029) and female gender (OR = 2.86; p = 0.013) were associated with an increased risk of vessel perforation. Lesions > 10 mm in length (OR = 0.45; p = 0.206), calcified stenoses (OR = 0.26; p = 0.088) and saphenous vein graft lesions (OR = 0.50; p = 0.295) were not at increased risk. Vessel perforation was seen in 10 (8.3%) of 120 lesions in which the laser catheter was equivalent in diameter to the target vessel (< or = 0.5 mm smaller in size) but in only 8 (1.5%) of 525 lesions in which the laser catheter was > 1 mm smaller than the target vessel (p = 0.001). CONCLUSIONS Most lesions thought to be suitable for excimer laser treatment are not at increased risk of perforation. The complication may be avoided by improved patient and laser catheter size selection.
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Affiliation(s)
- J A Bittl
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115
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21
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Parker JD, Ganz P, Selwyn AP, Bittl JA. Successful treatment of an excimer laser-associated coronary artery perforation with the Stack perfusion catheter. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:118-23. [PMID: 2009560 DOI: 10.1002/ccd.1810220210] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 64-year-old woman underwent excimer laser angioplasty of the right coronary artery. The procedure was complicated by perforation, which was successfully managed without complication with a Stack perfusion catheter. This report describes successful nonsurgical treatment of laser-induced coronary perforation and makes recommendations for avoiding this complication in other patients.
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Affiliation(s)
- J D Parker
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
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22
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Pinkerton CA, Slack JD, Orr CM, Vantassel JW, Smith ML. Percutaneous transluminal angioplasty in patients with prior myocardial revascularization surgery. Am J Cardiol 1988; 61:15G-22G. [PMID: 2966560 DOI: 10.1016/s0002-9149(88)80027-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Direct myocardial revascularization surgery using either the saphenous vein or internal mammary artery has become the definitive surgical treatment for coronary artery occlusive disease. Certain patients who have undergone these procedures, however, have recurrent myocardial ischemia due to progression of disease in unbypassed vessels, to obstruction in the arteries distal to the insertion of the bypass conduit, or to disease of the conduit itself. Balloon angioplasty may be used to relieve myocardial ischemia in these situations; however, initial studies suggested a low primary success rate coupled with excessive mortality and morbidity. Improvements in patient selection, equipment and technical expertise now allow angioplasty to be performed in this patient population with results comparable to that in the general coronary angioplasty population. Of the 3,016 angioplasty procedures performed between September 1980 and June 1987, 236 patients had previously undergone revascularization surgery. The primary success rate was 93% (390 of 419 stenoses successfully dilated). Overall, clinical restenosis was observed in 39%, including a 43% restenosis rate in patients undergoing only saphenous vein graft angioplasty. This did not differ appreciably from the restenosis rate in postbypass patients undergoing angioplasty of only native vessels (37%) or internal mammary arteries (42%). Emergency revascularization surgery was required in 7 of 236 patients (3%), each of whom had myocardial infarction. One of 236 patients (0.4%) died. Thus, angioplasty may be used to relieve recurrent myocardial ischemia in patients with prior direct myocardial revascularization procedures with a high initial success rate and acceptable risk. Early (less than 6 months) restenosis is not infrequent and remains the largest obstacle to a satisfactory clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C A Pinkerton
- Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis 46260
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Kussmaul WG. Percutaneous angioplasty of coronary bypass grafts: an emerging consensus. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1988; 15:1-4. [PMID: 2900686 DOI: 10.1002/ccd.1810150102] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- W G Kussmaul
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
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