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Zheng X, Wang Y, Mei Y, Lai C, Wang Y. Successful Hemostasis With Prolonged Balloon Inflation at the Proximal Site of the Coronary Perforation. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231183318. [PMID: 37363276 PMCID: PMC10285455 DOI: 10.1177/11795476231183318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
Coronary perforation (CP) is a rare complication of percutaneous coronary intervention (PCI) and can lead to pericardial tamponade. Prolonged balloon inflation is a reasonable treatment for CP, but there is no standard recommendation on the preferable choice between the balloon site for prolonged balloon inflation (ie, proximal and in situ of the perforation). We present a rare case of successful prolonged balloon inflation at the proximal site of the CP after the failure of balloon inflation at the site of perforation. The patient developed CP during balloon inflation post-stent, rapidly progressing to cardiac tamponade. In situ prolonged balloon inflation (3 times) failed to close the CP, but proximal inflation could manage the CP. The take-home message from this case is that balloon expansion at the proximal site could be better than in situ of perforation in patients with CP after PCI.
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Affiliation(s)
| | - Yunxiang Wang
- Yunxiang Wang, Yongkang First People’s Hospital, No. 599, Jinshan West Road, Yongkang, Zhejiang Province 321300, China.
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Mikhail P, Howden N, Monjur M, Jeyaprakash P, Said C, Bland A, Collison D, McCartney P, Adamson C, Morrow A, Carrick D, McEntegart M, Ford TJ. Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002076. [PMID: 36270713 PMCID: PMC9594565 DOI: 10.1136/openhrt-2022-002076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP). METHODS Prospective systematic review and meta-analysis including meta-regression using MEDLINE and EMBASE to November 2020. We included 'all-comer' PCI cohorts including large PCI registries and randomised controlled trials and excluding registries or trials limited to PCI in high-risk populations such as chronic total occlusion PCI or cohorts treated only with atheroablative devices. Regression analysis and corresponding correlation coefficients were performed comparing perforation incidence, mortality rate, tamponade rate and the rate of Ellis III perforations against the midpoint (year) of data collection to determine if a significant temporal relationship was present. RESULTS 3997 studies were screened for inclusion. 67 studies met eligibility criteria with a total of 5 568 191 PCIs included over a 38-year period (1982-2020). The overall pooled incidence of perforation was 0.39% (95% CI 0.34% to 0.45%) and remained similar throughout the study period. Around 1 in 5 coronary perforations led to tamponade (21.1%). Ellis III perforations are increasing in frequency and account for 43% of all perforations. Perforation mortality has trended lower over the years (7.5%; 95% CI 6.7% to 8.4%). Perforation risk factors derived using meta-regression were female sex, hypertension, chronic kidney disease and previous coronary bypass grafting. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%. CONCLUSION Coronary perforation complicates approximately 1 in 250 PCIs. Ellis III perforations are increasing in incidence although it is unclear whether this is due to reporting bias. Despite this, the overall perforation mortality rate (7.5%) has trended lower in recent years. Limitations of our findings include bias that may be introduced through analysis of multidesign studies and registries without pre-specified standardised perforation reporting CMore research into coronary perforation management including the optimal use of covered stents seems warranted. PROSPERO REGISTRATION NUMBER CRD42020207881.
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Affiliation(s)
- Philopatir Mikhail
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicklas Howden
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Mohammad Monjur
- Department of Cardiology, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Prajith Jeyaprakash
- Department of Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
| | - Christian Said
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Adam Bland
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Damien Collison
- Department of Cardiology, Golden Jubilee Hospital, Clydebank, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter McCartney
- Department of Cardiology, Golden Jubilee Hospital, Clydebank, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carly Adamson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | | | - Thomas J Ford
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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The balloon occlusion and thrombus aspiration catheter mediated-distal coronary perfusion technique (BI-RESCUE) for treatment of coronary artery perforation. J Geriatr Cardiol 2021; 18:150-154. [PMID: 33747065 PMCID: PMC7940969 DOI: 10.11909/j.issn.1671-5411.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The prevalence, management and outcomes of coronary artery perforations during percutaneous coronary intervention in patients with or without acute coronary syndromes. Coron Artery Dis 2021; 32:610-617. [PMID: 33471469 DOI: 10.1097/mca.0000000000001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention (PCI). The aim of this study was to compare early and late clinical outcomes of CAP in patients with or without acute coronary syndromes (ACS). METHOD A retrospective review was made of the procedural records of 15 878 patients who underwent PCI at two large tertiary centers between January 2012 and December 2018. A total of 51 (0.32 %) CAP cases were identified. RESULTS Of the 51 CAP cases, 26 (51.0%) patients had ACS and 25 (49%) patients had stable coronary artery disease (CAD). The major cause of perforation was stenting (43%). Cardiac tamponade was more frequent in the ACS group than stable CAD group (34.6 vs. 8%; P = 0.024). Kaplan-Meier analysis showed that the overall 30-day cardiovascular mortality rate was higher in patients with ACS than stable CAD (23.1 vs. 0%; P = 0.011). At the 3-year follow-up examination, no statistically significant difference was determined between the two groups in respect of all-cause mortality (36.1 vs. 28.4%; P = 0.262). Multivariable Cox regression analysis demonstrated left ventricular ejection fraction (hazard ratio, 0.94; 95% CI, 0.89-0.99; P = 0.033) but not ACS at presentation (hazard ratio, 1.39; 95% CI, 0.37-5.20; P = 0.628) as a predictor of mortality at 3 years. CONCLUSIONS Early clinical outcomes following CAP, including cardiac tamponade and 30-day cardiovascular mortality, were significantly worse in patients with ACS compared to stable CAD.
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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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Isogai T, Yasunaga H, Matsui H, Tanaka H, Fushimi K. Relationship between hospital volume and major cardiac complications of rotational atherectomy: A nationwide retrospective cohort study in Japan. J Cardiol 2016; 67:442-8. [DOI: 10.1016/j.jjcc.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
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Ishihara S, Tabata S, Inoue T. A novel method to bail out coronary perforation: Micro-catheter distal perfusion technique. Catheter Cardiovasc Interv 2015; 86:417-21. [DOI: 10.1002/ccd.26018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Shozo Ishihara
- Department of Cardiology; Mimihara General Hospital; Osaka Japan
| | - Shiro Tabata
- Department of Cardiology; Mimihara General Hospital; Osaka Japan
| | - Takehiro Inoue
- Department of Cardiology; Mimihara General Hospital; Osaka Japan
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Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention. Cardiol Res Pract 2014; 2014:784018. [PMID: 25506463 PMCID: PMC4258336 DOI: 10.1155/2014/784018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 12/31/2022] Open
Abstract
Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.
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Srinivas SK, Patra S, Ramalingam R, Agrawal N, Syed T, Shankarappa RK, Manjunath CN. Successful management of Ellis type III left anterior descending artery perforation following percutaneous coronary intervention by a covered stent: Successfully resolved the dramatic complication. J Cardiovasc Dis Res 2014; 4:245-7. [PMID: 24653590 DOI: 10.1016/j.jcdr.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 01/12/2014] [Indexed: 11/26/2022] Open
Abstract
Coronary artery perforation is a rare but catastrophic complication of percutaneous coronary intervention (PCI). Grade III coronary perforation and rupture invariably results in pericardial effusion and tamponade requiring urgent pericardiocentesis. Advances in coronary intervention have increased the opportunity to treat coronary artery perforation. We are reporting a case of 55 years old hypertensive female who presented with effort angina. Coronary angiogram revealed significant stenosis in the left anterior descending coronary artery. Post PCI, she had Ellis type III coronary perforation and pericardial tamponade and cardiogenic shock. The patient was resuscitated, pericardiocentesis done, autologous blood transfusion given and covered stent deployed.
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Affiliation(s)
- Sunil Kumar Srinivas
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
| | - Soumya Patra
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
| | - Rangaraj Ramalingam
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
| | - Navin Agrawal
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
| | - Tanveer Syed
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
| | - Ravindranath K Shankarappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India
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Meincke F, Kuck KH, Bergmann MW. Cardiac tamponade due to coronary perforation during percutaneous interventions successfully treated with microspheres. Clin Res Cardiol 2014; 103:325-7. [PMID: 24398706 DOI: 10.1007/s00392-013-0651-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Felix Meincke
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099, Hamburg, Germany,
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Ye F, Liang Q, Luo SH, Hong LF. Coronary artery perforation complicated with acute aortic valve regurgitation during percutaneous coronary intervention: report of two cases. ACTA ACUST UNITED AC 2014; 28:250-3. [PMID: 24382232 DOI: 10.1016/s1001-9294(14)60015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Fei Ye
- Institute of Cardiovascular Sciences of Jianghan University & the Fifth Hospital of Wuhan, Wuhan 430050, China
| | - Qin Liang
- Institute of Cardiovascular Sciences of Jianghan University & the Fifth Hospital of Wuhan, Wuhan 430050, China
| | - Song-hui Luo
- Institute of Cardiovascular Sciences of Jianghan University & the Fifth Hospital of Wuhan, Wuhan 430050, China
| | - Li-feng Hong
- Institute of Cardiovascular Sciences of Jianghan University & the Fifth Hospital of Wuhan, Wuhan 430050, China
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Murthy A, Singh A, Driesman MH. Acquired Coronary Cameral Fistula Due to Post Stent Balloon Dilatation: Dual Coronary Artery Perforations into the Left Ventricle—What Is the Right Treatment? ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcd.2014.411066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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