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ZOU YL, LI JQ, WANG DY, GONG YT, SHENG L, LI Y. Conquer coronary artery perforation with magic hands. J Geriatr Cardiol 2024; 21:379-386. [PMID: 38800547 PMCID: PMC11112151 DOI: 10.26599/1671-5411.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Coronary artery perforation (CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the perforation of large vessels involves the placement of a covered stent, while the perforation of distal and collateral vessels is typically managed using coils, autologous skin, subcutaneous fat, microspheres, gelatin sponge, thrombin or other substances. However, the above techniques have certain limitations and are not applicable in all scenarios. Our team has developed a range of innovative strategies for effectively managing CAP. This article provides an insightful review of the various tips and tricks for the treatment of CAP.
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Affiliation(s)
- Yi-Lun ZOU
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian-Qiang LI
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ding-Yu WANG
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong-Tai GONG
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li SHENG
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue LI
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Yi T, Chen W, Wu Y, Pan Z, Lin X, Lin D, Chen R, Zheng X. Intra-Arterial Injection of Thrombin as Rescue Therapy of Vessel Perforation during Mechanical Thrombectomy for Acute Ischemic Stroke. Brain Sci 2022; 12:760. [PMID: 35741645 PMCID: PMC9221224 DOI: 10.3390/brainsci12060760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Vessel perforation during stent mechanical thrombectomy (MT) is a rare and disastrous complication. A routine rescue strategy includes balloon occlusion for tamponade, procedure suspension, and lowering or normalizing blood pressure. However, this complication is still associated with poor outcome and high mortality. OBJECTIVE We present our experience with intra-arterial injection of thrombin in the treatment of vessel perforation secondary to microcatheter/microwire perforation, which prevents further deterioration in clinical outcomes. METHODS Cases with intraprocedural vessel perforation during mechanical thrombectomy were included in the final analysis. Clinical data, procedural details, and radiographic and clinical outcomes were collected. RESULTS Four patients with intraprocedural vessel perforation were included. Intraprocedural perforations occurred at the distal middle cerebral artery in two cases: the A2 segment in one case and the internal carotid artery terminus in one case. The etiology of four cases was intracranial atherosclerotic stenosis (ICAS). The ruptured vessels were effectively occluded in all cases. Endovascular therapy was continued in three cases, and mTICI ≥ 2b recanalization was achieved in all cases. The culprit artery was kept patent on CTA for 72 h post-operation. No active bleeding was detected on follow-up CT post-operation. During the 90-day follow-up period, one patient died, modified Rankle Scare (mRS) 3 was observed in two patients, and mRS 4 was observed in one patient. CONCLUSIONS The key benefit of this method is occluding the ruptured vessel without affecting the following MT. We propose that intra-arterial injection of prothrombin may be simple yet effective in managing vessel perforation complications during MT.
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Affiliation(s)
| | - Wenhuo Chen
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (Z.P.); (X.L.); (D.L.); (R.C.); (X.Z.)
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Caixeta A, Oliveira MDP, Dangas GD. Coronary Artery Dissections, Perforations, and the No‐Reflow Phenomenon. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kassier A, Fischell TA. Managing coronary artery perforation after percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2022; 20:215-222. [PMID: 35341445 DOI: 10.1080/14779072.2022.2059465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Coronary artery perforation is a serious complication during percutaneous coronary intervention that results in significant increase in morbidity and mortality. In this article, we provide a state-of-the-art overview of the contemporary management of coronary perforation and the possible scenarios that operators may run into during percutaneous coronary interventions. AREA COVERED Coronary perforation during percutaneous coronary intervention. Literature search was performed using PubMed and Google Scholar to identify the most recently published articles covering this topic. EXPERT OPINION As part of this review, we also provide an expert commentary discussing the nuances in the recognition and management of coronary artery perforation, in addition to future directions, and improvements in technology that could make the management of coronary perforation safer and more effective.
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Affiliation(s)
- Adnan Kassier
- Department of interventional cardiology, Ascension Borgess Hospital, Kalamazoo, Michigan, United States
| | - Tim A Fischell
- Department of interventional cardiology, Ascension Borgess Hospital, Kalamazoo, Michigan, United States
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Moroni F, Brilakis ES, Azzalini L. Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Rev Cardiovasc Ther 2021; 19:71-87. [PMID: 33175595 DOI: 10.1080/14779072.2021.1850264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Coronary artery perforation (CAP) is an infrequent (<1%) complication of percutaneous coronary intervention (PCI), that can lead to dramatic consequences, including tamponade and death. The incidence of CAP is higher (4-9%) in chronic total occlusion (CTO) PCI due higher complexity of these lesions and the techniques used to recanalized them. AREAS COVERED In this Expert Review, we discuss the specific features of CTO PCI predisposing to CAP. We also describe the typical procedural scenarios in which CAP can occur and provide a universal management algorithm. Currently available devices and techniques for CAP treatment are presented in detail. Finally, we discuss imaging support for diagnosis of pericardial effusion in CAP as well as medical and surgical management. EXPERT OPINION With increasing volumes and complexity of CTO PCI, the incidence of CAP is likely to rise. Adherence to good catheterization laboratory practices, availability of dedicated equipment to seal CAP, perform pericardiocentesis, and provide hemodynamic support, as well as adequate training, are pillars for the prevention and optimal management of CAP during CTO PCI.
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Affiliation(s)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
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Tremmel JA. Perforation Mechanisms, Risk Stratification, and Management in the Non-post Coronary Artery Bypass Graft Patient. Interv Cardiol Clin 2020; 10:93-99. [PMID: 33223111 DOI: 10.1016/j.iccl.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer A Tremmel
- Stanford University Medical Center, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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Sanz Sanchez J, Garbo R, Gagnor A, Oreglia J, Mazzarotto P, Maurina M, Regazzoli D, Gasparini GL. Management and outcomes of coronary artery perforations treated with the block and deliver technique. Catheter Cardiovasc Interv 2020; 98:238-245. [DOI: 10.1002/ccd.29241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jorge Sanz Sanchez
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Roberto Garbo
- Department of Invasive Cardiology San Giovanni Bosco Hospital Turin Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology Maria Vittoria Hospital Turin Italy
| | - Jacopo Oreglia
- Department of Invasive Cardiology Niguarda Hospital Milan Italy
| | | | - Matteo Maurina
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Damiano Regazzoli
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Gabriele L. Gasparini
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
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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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Vemmou E, Nikolakopoulos I, Xenogiannis I, Megaly M, Hall A, Wang Y, Chavez I, Garcia S, Burke MN, Brilakis ES. Recent advances in microcatheter technology for the treatment of chronic total occlusions. Expert Rev Med Devices 2019; 16:267-273. [PMID: 30929525 DOI: 10.1080/17434440.2019.1602039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Use of a microcatheter is essential for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Several microcatheters have recently been introduced in clinical practice aiming to improve deliverability and resistance to deformation. Areas covered: We review the technical characteristics of several new microcatheters (Mamba, Mamba Flex, Teleport Control, Teleport, Nhancer Rx, Sasuke, and ReCross) and compare them with existing microcatheters. Expert opinion: The recently developed microcatheters offer additional options for guidewire support during CTO PCI. Accumulation of clinical experience and performance of comparative effectiveness studies are needed for better understanding the role of these devices in contemporary CTO PCI.
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Affiliation(s)
- Evangelia Vemmou
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Ilias Nikolakopoulos
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Iosif Xenogiannis
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Michael Megaly
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Allison Hall
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Yale Wang
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Ivan Chavez
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Santiago Garcia
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - M Nicholas Burke
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , Abbott Northwestern Hospital , Minneapolis , MN , USA
| | - Emmanouil S Brilakis
- a Minneapolis Heart Institute and Minneapolis Heart Institute Foundation , 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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Balaban Y, Bektaş O, Bayramoğlu A, Gümrükçüoğlu HA, Kayışoğlu AH. Imaging behind occluded areas with an iatrogenic perforated balloon: A safe, practical, and simple new method of visualizing the distal lumen in total occlusion. J Interv Cardiol 2017; 30:544-549. [DOI: 10.1111/joic.12444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yakup Balaban
- Department of Cardiology; Vm Medical Park Kocaeli Hospital; Başiskele Kocaeli Turkey
| | - Osman Bektaş
- Department of Cardiology; Ordu University Medical School; Ordu Turkey
| | - Adil Bayramoğlu
- Department of Cardiology; Ordu University Medical School; Ordu Turkey
| | - Hasan A. Gümrükçüoğlu
- Department of Cardiology; Vm Medical Park Kocaeli Hospital; Başiskele Kocaeli Turkey
| | - Ali H. Kayışoğlu
- Department of Cardiology; Vm Medical Park Kocaeli Hospital; Başiskele Kocaeli Turkey
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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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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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