1
|
Coronary artery bypass grafting after iatrogenic coronary artery dissection: A single center eight years' experience. COR ET VASA 2023. [DOI: 10.33678/cor.2022.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
2
|
Verevkin A, von Aspern K, Leontyev S, Lehmann S, Borger MA, Davierwala PM. Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8:e010940. [PMID: 30612504 PMCID: PMC6405713 DOI: 10.1161/jaha.118.010940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022]
Abstract
Background Iatrogenic coronary artery injuries during percutaneous coronary interventions ( PCI ) often require emergent surgical management. Our study evaluated the early and long-term outcomes in patients undergoing surgical treatment of iatrogenic PCI complications and identified the predictors of operative and long-term mortality. Methods and Results Pre-, intra- and post-operative data and hospital outcomes of 168 consecutive patients undergoing cardiac surgical procedures for iatrogenic complications following PCI between December 1999 and July 2015, were prospectively collected in our computerized database. Logistic and Cox regression analyses were used to identify the independent predictors of operative and long-term mortality. The mean age was 68.5±10.2 years and 35.7% were females. PCI complications included left anterior descending (38.7%), right coronary (29.2%), circumflex (13.1%), left main coronary artery injuries (19.0%), and acute myocardial infarction (66.7%), Type A aortic dissection (7.7%), cardiac tamponade (17.9%), and cardiogenic shock ( CS ) (46.4%). Operative mortality for corrective surgery was 20.8% and was independently predicted by critical preoperative state (odds ratio: 3.5; P=0.01). The 5- and 10-year survival for all patients was 63.9±4.0% and 49.6±5.0%, which improved remarkably in hospital survivors (79.0±4.0% and 64.0±6.0%). Risk factors for long-term mortality were critical preoperative state (hazard ratio: 3.5; P<0.0001) and coronary artery occlusion during PCI (hazard ratio: 2.6; P=0.002). The 5- and 10-year freedom from major adverse cardiac and cerebrovascular events was 59.7±4.0% and 41.9±5.0%. Conclusions Iatrogenic injuries after PCI or coronary angiography requiring surgical correction are associated with a high operative and long-term mortality. Patients developing acute coronary artery occlusion have a more guarded long-term prognosis. Hospital survivors, however, have a superior long-term survival.
Collapse
Affiliation(s)
| | | | - Sergey Leontyev
- University department of Cardiac SurgeryLeipzig Heart CenterGermany
| | - Sven Lehmann
- University department of Cardiac SurgeryLeipzig Heart CenterGermany
| | | | | |
Collapse
|
3
|
Hybrid coronary revascularization as a safe, feasible, and viable alternative to conventional coronary artery bypass grafting: what is the current evidence? Minim Invasive Surg 2013; 2013:142616. [PMID: 23691303 PMCID: PMC3649801 DOI: 10.1155/2013/142616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/13/2013] [Indexed: 11/30/2022] Open
Abstract
The “hybrid” approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior
descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is
performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium
against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between
93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter
hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC)
transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients
treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated
patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of
multivessel coronary artery disease in a selected patient population.
Collapse
|
4
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
5
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
6
|
Abstract
Is the requirement for onsite surgical back-up in centres performing percutaneous coronary intervention still relevant today?
Collapse
|
7
|
Haan CK, O'Brien S, Edwards FH, Peterson ED, Ferguson TB. Trends in Emergency Coronary Artery Bypass Grafting After Percutaneous Coronary Intervention, 1994–2003. Ann Thorac Surg 2006; 81:1658-65. [PMID: 16631652 DOI: 10.1016/j.athoracsur.2005.09.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 09/28/2005] [Accepted: 09/30/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the last decade, percutaneous coronary intervention (PCI) has undergone profound changes in techniques used to achieve revascularization and in patient selection. We examine trends in emergency surgical revascularization after PCI. METHODS Using The Society of Thoracic Surgeons National Cardiac Surgery Database, we examined patients undergoing coronary artery bypass grafting within 6 hours of PCI from 1994 to 2003. Stratifying into groups of patients who had and had not suffered myocardial infarction within 24 hours of PCI followed by coronary artery bypass grafting (CABG), we tracked trends in characteristics, predicted risk, and clinical outcomes. RESULTS The proportion of isolated CABG procedures done emergently after PCI decreased over 1994 to 1999 from 3,357 of 115,679 (2.9%) to 1,227 of 155,831 (0.8%), remaining stable through 2003. Those suffering myocardial infarction within 24 hours made up a constant proportion of isolated CABG as emergency after PCI (3,352 of 1,042,864; 0.3%) since 1997. Over the decade, the preoperative risk profile worsened, including more elderly patients and more with cerebrovascular disease and congestive heart failure. Operative mortality among these patients has risen with time (from 8.0% to 9.3%; p < 0.0001 for trend), particularly in the setting of acute myocardial infarction (from 14.1% to 16.6%; p < 0.0001 for trend). Similarly, postoperative complications have increased over time, most notably seen in the need for reoperation (10.62% to 24.56%), prolonged postoperative ventilation (25.65% to 54.58%), and renal failure (10.22% to 18.55%). CONCLUSIONS In 2005, there remains a low but real need for emergent CABG after PCI, in which operative outcomes are less than ideal, especially in the postinfarction patient, representing an area for cross-specialty collaboration.
Collapse
Affiliation(s)
- Constance K Haan
- Division of Cardiothoracic Surgery, University of Florida/Jacksonville, Jacksonville, Florida, USA.
| | | | | | | | | |
Collapse
|
8
|
Dehmer GJ, Gantt DS. Coronary intervention at hospitals without on-site cardiac surgery: are we pushing the envelope too far?**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2004; 43:343-5. [PMID: 15013112 DOI: 10.1016/j.jacc.2003.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
9
|
Lotfi M, Mackie K, Dzavik V, Seidelin PH. Impact of delays to cardiac surgery after failed angioplasty and stenting. J Am Coll Cardiol 2004; 43:337-42. [PMID: 15013111 DOI: 10.1016/j.jacc.2003.08.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Revised: 07/30/2003] [Accepted: 08/05/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study was designed to determine the likelihood of harm in patients having additional delays before urgent coronary artery bypass graft (UCABG) surgery after percutaneous coronary intervention (PCI). BACKGROUND Patients who have PCI at hospitals without cardiac surgery have additional delays to surgery when UCABG is indicated. METHODS Detailed chart review was performed on all patients who had a failed PCI leading to UCABG at a large tertiary care hospital. A prespecified set of criteria (hemodynamic instability, coronary perforation with significant effusion or tamponade, or severe ischemia) was used to identify patients who would have an increased likelihood of harm with additional delays to surgery. RESULTS From 1996 to 2000, 6,582 PCIs were performed. There were 45 patients (0.7%) identified to have UCABG. The demographic characteristics of the UCABG patients were similar to the rest of the patients in the PCI database, except for significantly more type C lesions (45.3% vs. 25.0%, p < 0.001) and more urgent cases (66.6% vs. 49.8%, p = 0.03) in patients with UCABG. Myocardial infarction occurred in eight patients (17.0%) after UCABG, with a mean peak creatine kinase of 2,445 +/- 1,212 IU/l. Death during the index hospital admission occurred in two patients. Eleven of the 45 patients (24.4%) were identified by the prespecified criteria to be at high likelihood of harm with additional delays to surgery. The absolute risk of harm is approximately one to two patients per 1,000 PCIs. CONCLUSIONS Approximately one in four patients referred for UCABG would be placed at increased risk of harm if delays to surgery were encountered.
Collapse
Affiliation(s)
- Mat Lotfi
- Division of Cardiology, Department of Medicine, University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, EN 12-238, Toronto, Ontario M5G 2C4, Canada
| | | | | | | |
Collapse
|
10
|
Barakate MS, Bannon PG, Hughes CF, Horton MD, Callaway A, Hurst T. Emergency surgery after unsuccessful coronary angioplasty: a review of 15 years' experience. Ann Thorac Surg 2003; 75:1400-5. [PMID: 12735553 DOI: 10.1016/s0003-4975(02)05026-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Emergency coronary artery bypass grafting (CABG) is occasionally necessary for failed percutaneous transluminal coronary angioplasty (PTCA). The aim of this study was to assess the outcome of patients receiving emergency CABG after unsuccessful PTCA over a 15-year study period. METHODS From January 1982 through December 1996, 74 patients underwent emergency CABG after unsuccessful PTCA (crash group). This group was compared with a matched group of 74 patients having primary elective CABG (control group). RESULTS All 74 crash group patients were to have PTCA of one coronary system. After PTCA failure, 58 patients (78.3%) developed electrocardiographic changes of evolving acute myocardial infarction (AMI). The overall rate of AMI was 8.1% for the crash group and 2.7% for the control group. Two patients in the crash group died, with no deaths in the control group. There was no significant difference between mean in-hospital length of stay. CONCLUSIONS With prompt, aggressive, and complete myocardial revascularization, patients who required emergency CABG after PTCA failure had an outcome not significantly different from that of patients having elective CABG.
Collapse
Affiliation(s)
- Michael S Barakate
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
11
|
Velianou JL, Strauss BH, Kreatsoulas C, Pericak D, Natarajan MK. Evaluation of the role of abciximab (Reopro) as a rescue agent during percutaneous coronary interventions: in-hospital and six-month outcomes. Catheter Cardiovasc Interv 2000; 51:138-44. [PMID: 11025564 DOI: 10.1002/1522-726x(200010)51:2<138::aid-ccd2>3.0.co;2-u] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abciximab is effective for the prevention of complications when administered prior to percutaneous coronary intervention (PCI). The efficacy and safety of abciximab as an unplanned or rescue agent for complications of PCI is unknown. Rescue versus planned use was compared in 186 consecutive patients. Primary or rescue PCI for acute myocardial infarction (MI) and shock were excluded. Rescue abciximab use was undertaken in 101 patients (54.3%) and planned abciximab was used in 85 (45.7%). The rescue abciximab patients had a lower incidence of previous MI, preprocedural thrombus, multivessel, and vein graft intervention. In-hospital endpoints in the rescue versus planned abciximab patients were death (1.0% vs. 1. 2%, P = 1.0), Q-wave MI (2.0% vs. 2.4%, P = 1.0), any MI (14.9% vs. 9.4%, P = 0.3), target vessel revascularization (TVR; 0% vs. 1.2%, P = 1.0), and composite (15.8% vs. 10.6%, P = 0.3). At 6 months, events were death (4.0% vs. 2.3%, P = 0.69), MI (14.9% vs. 9.4%, P = 0.26), TVR (20.8% vs. 4.7%, P = 0.001), and composite (30.7% vs. 15. 3%, P = 0.01). In-hospital complications between the rescue and planned abciximab patients of major bleed (1.0% vs. 1.8%, P = NS), stroke (0% vs. 1.8%, P = NS), and thrombocytopenia (3.0% vs. 1.8%, P = NS) were similar. There was a significantly higher procedural time (99.6 min vs. 86.1 min, P = 0.02), contrast volume (278.8 ml vs. 223. 5 ml, P = 0.04), and heparin use (8984 u vs. 6003 u, P = 0.0006) in the rescue group. In this nonrandomized comparison, rescue abciximab allowed for the safe discharge from hospital in the majority of patients. However, during a 6-month follow-up, more patients treated with rescue abciximab required TVR with either repeat PCI or CABG. Further studies are warranted to evaluate the overall strategy of rescue abciximab use in PCI.
Collapse
Affiliation(s)
- J L Velianou
- Division of Cardiology, Department of Medicine, Preventative Cardiology and Therapeutics Hamilton Health Sciences Corp., General Campus McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | |
Collapse
|
12
|
Wittwer T, Cremer J, Boonstra P, Grandjean J, Mariani M, Mügge A, Drexler H, den Heijer P, Leitner ER, Hepp A, Wehr M, Haverich A. Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study. Heart 2000; 83:58-63. [PMID: 10618337 PMCID: PMC1729254 DOI: 10.1136/heart.83.1.58] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybrid procedure combining surgical revascularisation of the left anterior descending artery with interventional procedures for additional coronary lesions has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented. DESIGN AND PATIENTS Since December 1996, 35 patients (29 male, 6 female, mean (SD) age 56.7 (17) years) underwent a hybrid revascularisation performed as a primary MIDCAB procedure for grafting of the left anterior descending artery with the left internal mammary artery, followed by staged angioplasty and stenting of additional coronary lesions. RESULTS After MIDCAB grafting the postoperative course was uneventful in all patients. Coronary reangiography after a median of seven days revealed patent and functioning left internal mammary artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 47 lesions were treated successfully. Procedure related complications did not occur. All patients remained free from angina and no stress ECG changes were recorded. CONCLUSIONS The preliminary results of this hybrid approach to myocardial revascularisation suggest that this is a safe and effective procedure for complete revascularisation in selected patients with multivessel disease. Elderly and reoperative patients with significant comorbidity may benefit especially from such hybrid procedures by avoiding cardiopulmonary bypass and mid sternotomy.
Collapse
Affiliation(s)
- T Wittwer
- Department of Cardiothoracic Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Loubeyre C, Morice MC, Berzin B, Virot P, Commeau P, Drobinski G, Ethevenot G, Moquet B, Marco J, Labrunie P, Cattan S, Coste P, Aubry P, Ferrier A. Emergency coronary artery bypass surgery following coronary angioplasty and stenting: results of a French multicenter registry. Catheter Cardiovasc Interv 1999; 47:441-8. [PMID: 10470474 DOI: 10.1002/(sici)1522-726x(199908)47:4<441::aid-ccd12>3.0.co;2-s] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigates the influence of coronary stenting on the risk of emergency bypass surgery performed within 24 hr of percutaneous transluminal coronary angioplasty (PTCA) with particular concern for incidence and indication. Since 1995, coronary stenting has been increasingly performed in France during angioplasty procedures, altering significantly the role of emergency bypass surgery. The outcome of elective stenting and widespread use of coronary stenting and its influence on emergency surgery have not been evaluated so far. Through a retrospective (1995) and prospective (1996) registry, we analyzed the incidence, indication and results of emergency bypass surgery performed within 24 hr of PTCA in 68 and 57 centers, respectively, accounting for nearly half of all angioplasty procedures in France. Data were collected through questionnaires consisting of separate forms for every case report that were sent to every center. Over the two years, 26,885 and 27,497 procedures were investigated with a stenting rate of 46% and 64%, respectively. The observed need for emergency surgery was constantly low throughout this period (0.38% and 0.32%, respectively). Indications for surgery included complications directly due to stent in 37% of cases in the 2-year period. Outcome remained poor, with in-hospital mortality in 10% and 17% and myocardial infarction in 27% and 25% of cases, respectively. A comparison of the results in centers with and without surgical facilities showed no differences in outcome, despite a longer time to surgery (359 min +/- 406 min vs. 170 min +/- 205 min, P = 0.0001) and a lower incidence of emergency surgery (0.25% vs. 0.44%, P = 0.0001) in centers without on-site surgery backup. The French multicenter registry reveals an increase in the use of stents together with a dramatic decrease in the incidence of emergency bypass surgery (below 0.5%) following PTCA. There has been a significant evolution in the indication, and stent implantation now accounts for a third of the indications for emergency bypass surgery.
Collapse
Affiliation(s)
- C Loubeyre
- Institut Cardiovasculaire Paris Sud, Quincy, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Brueren BR, Mast EG, Suttorp MJ, Ernst JM, Bal ET, Plokker HW. How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby. Catheter Cardiovasc Interv 1999; 46:257-62. [PMID: 10348119 DOI: 10.1002/(sici)1522-726x(199903)46:3<257::aid-ccd1>3.0.co;2-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest-risk category complications can occur.
Collapse
Affiliation(s)
- B R Brueren
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | | | | |
Collapse
|
15
|
Caus T, Canavy I, Mesana T, Garcia E, Raoul-Monties J. Rescue revascularization for acute coronary occlusion late after radiotherapy. Ann Thorac Surg 1999; 67:236-8. [PMID: 10086560 DOI: 10.1016/s0003-4975(98)01146-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Because radiation-induced coronary artery stenoses are frequently severe and located proximally, some patients are admitted in emergency. This report describes the case of a 47-year-old woman with radiation-induced stenosis of the left main coronary artery who presented with cardiac arrest during angiography. The patient was successfully treated using circulatory assistance and percutaneous transluminal coronary angioplasty as a bridge to coronary artery bypass grafting.
Collapse
Affiliation(s)
- T Caus
- Department of Cardiovascular Surgery, Timone Hospital, University Aix-Marseille II, Marseilles, France
| | | | | | | | | |
Collapse
|
16
|
|
17
|
Abstract
Percutaneous coronary interventions have been performed for 20 years. Despite the success and progress of these interventions, abrupt vessel closure has been a dramatic adverse event of coronary interventions. Closure has frequently led to the major complications of death, myocardial infarction, and emergency coronary artery bypass. Because of the fear of this adverse event and its subsequent complications, the applicability of coronary interventions is sometimes limited. The pathologic characteristics of abrupt vessel closure have been recognized as predominantly caused by dissection, with vessel recoil and thrombus formation playing important secondary roles. The recognition of the lesions at risk for abrupt vessel closure has led to a strategy of lesion-specific device therapy to reduce complications. Similarly the role of antiplatelet and antithrombotic therapies have reduced complications. The earliest methods of dealing with abrupt closure was emergency coronary artery bypass surgery with significant rates of morbidity and mortality. With the advent of second-generation devices and techniques, particularly stents, the management of abrupt vessel closure has been simplified and alternatives to emergency coronary bypass are more available. This article will review the history and current status of the prevention and management of abrupt vessel closure and demonstrate that anticipation and management of this complication have been facilitated with reduction of subsequent complications and increased applicability of coronary interventions.
Collapse
Affiliation(s)
- B A Bergelson
- Department of Medicine, Veterans Administrative Lakeside Medical Center, Northwestern University Medical School, IL, USA
| | | | | |
Collapse
|
18
|
Furushima H, Matsubara T, Tamura Y, Yamazoe M, Konno T, Ida T, Aizawa Y, Moro H, Watanabe H, Eguchi S. Coronary artery perforation with subepicardial hematoma. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 41:59-61. [PMID: 9143770 DOI: 10.1002/(sici)1097-0304(199705)41:1<59::aid-ccd15>3.0.co;2-l] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coronary artery perforation is a relatively rare complication in coronary angioplasty. We report the case of a 71-year-old male, who was salvaged by emergency surgery, for cardiogenic shock due to subepicardial hematoma associated with balloon angioplasty. Such a case has not yet previously been reported.
Collapse
Affiliation(s)
- H Furushima
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|