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Tiwana J, Kearney KE, Lombardi WL, Azzalini L. Challenges in the diagnosis and management of dry tamponade. Catheter Cardiovasc Interv 2024. [PMID: 39354877 DOI: 10.1002/ccd.31241] [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] [Received: 08/12/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 10/03/2024]
Abstract
Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.
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Affiliation(s)
- Jasleen Tiwana
- Alaska Heart and Vascular Institute, Anchorage, Alaska, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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2
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Yokoi K, Yoshioka G, Node K. Handmade Embolization Coil for Managing Guidewire-Induced Coronary Perforation. JACC Case Rep 2024; 29:102528. [PMID: 39359971 PMCID: PMC11442211 DOI: 10.1016/j.jaccas.2024.102528] [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: 06/11/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 10/04/2024]
Abstract
This paper reports the case of an 83-year-old woman who underwent percutaneous coronary intervention in the left circumflex coronary artery complicated by a guidewire-induced perforation. Hemostasis was successfully achieved using a handmade coil prepared from available devices during percutaneous coronary intervention due to challenges with commercial microcoils.
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Affiliation(s)
- Kensuke Yokoi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Goro Yoshioka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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3
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Abdelaziz A, Hafez A, Atta K, Elsayed H, Elaraby A, Ibrahim AA, Gadelmawla AF, Helmi A, Abdelazeem B, Lavie CJ, Tafur-Soto J. Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis. Curr Probl Cardiol 2024; 49:102832. [PMID: 39293774 DOI: 10.1016/j.cpcardiol.2024.102832] [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: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI. METHODS We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI). RESULTS A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22). CONCLUSION Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed A Ibrahim
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Farid Gadelmawla
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Helmi
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Basel Abdelazeem
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Jose Tafur-Soto
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
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4
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Piccaro de Oliveira P, Abelin AP, Machado GP, Filho EM, Araujo GN, Côrtes LA, Padilla L, Peralta SP, Santiago R, de Paula JET, Botelho AC, Echavarria-Pinto M, Damas de Los Santos F, Harada M, Campos CM, Quadros AS. Evaluation of Success and Complications Scores for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the Latin American Registry. Am J Cardiol 2024; 227:1-10. [PMID: 39029723 DOI: 10.1016/j.amjcard.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention is a complex procedure and is associated with considerable risk of complications. Several success and complication scores have been developed; however, data regarding their external validation in other populations such as Latin America are scarce. This study aimed to evaluate the accuracy of the main predictors of success and complications in a broad cohort of procedures in the Latin American (LATAM) CTO registry. From April 2008 to December 2023, 3,706 consecutive procedures listed in the LATAM CTO registry were screened. Of these, 2,835 procedures had sufficient information to analyze the Multicenter CTO Registry in Japan (J-CTO); Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS); Ostial location, Rentrop grade, and Age (ORA); Clinical and Lesion-related Score (CL-score); and EuroCTO Score (CASTLE) success scores. The complication scores were PROGRESS (MACE, mortality, and pericardiocentesis) and Outcomes, Patient health status, and Efficiency iN Chronic Total Occlusion hybrid procedures (OPEN-CTO),OPEN-CLEAN. The J-CTO and CASTLE scores demonstrated the highest areas under the curve (AUC) of 0.718 and 0.703, respectively. The AUC value for the CL-score was 0.685, whereas the PROGRESS score had an AUC of 0.598 and the ORA AUC was 0.545. The level of agreement between scores was low; only 4% of the procedures were classified as difficult or very difficult by all scores and <1% were classified as easy by all 5 scores. Of the complication scores, PROGRESS mortality (AUC 0.651) and PROGRESS MACE (AUC 0.588) showed the best performance, identifying groups with >10% event rate. These results may improve the selection of revascularization techniques, especially for patient demographics that are historically underrepresented in CTO research.
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Affiliation(s)
- Pedro Piccaro de Oliveira
- Cardiology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Hospital Divina Providência, Porto Alegre, Brazil
| | - Anibal P Abelin
- Instituto do Coração de Santa Maria (ICOR), Santa Maria, Rio Grande do Sul, Brazil; Cardiology Department, Universidade Franciscana (UFN), Santa Maria, Rio Grande do Sul, Brazil
| | | | | | - Gustavo N Araujo
- Hospital Unimed Grande Florianópolis, São José, Brazil; Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Pablo Peralta
- Interventional Cardiology Department, Sanatorio Güemes University Hospital, Buenos Aires, Argentina
| | | | | | | | | | - Felix Damas de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; Centro Medico ABC, Mexico City, Mexico
| | - Marcelo Harada
- Hospital SOS Cardio, Florianópolis, Brazil; Imperial Hospital de Caridade, Florianópolis, Brazil
| | - Carlos M Campos
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre S Quadros
- Hospital Divina Providência, Porto Alegre, Brazil; Interventional Cardiology Department, Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
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5
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Pioch N, Monségu J. [When orbital exceeds its limits!]. Ann Cardiol Angeiol (Paris) 2024; 73:101783. [PMID: 39047396 DOI: 10.1016/j.ancard.2024.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
High calcified PCI are challenging because immediate and follow-up results are not optimal. We recommend using a specific preparation of these lesions, especially using atherectomy which can itself provide complications. We illustrate our comments with a clinical case where we have decided to treat a long-calcified lesion from left main to distal left artery descending with a specific preparation according orbital atherectomy. Procedure was complicated by a coronary perforation with favorable evolution. This case allows to report how to prevent a such complication and to remember how should we have to treat it.
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Affiliation(s)
- Nicolas Pioch
- Institut Cardiovasculaire, Groupe Hospitalier Mutualiste de Grenoble, 8 rue du Dr Calmette, 38000 Grenoble, France
| | - Jacques Monségu
- Institut Cardiovasculaire, Groupe Hospitalier Mutualiste de Grenoble, 8 rue du Dr Calmette, 38000 Grenoble, France.
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Siu V, Parfrey S, Li C, Graham JJ, Wijeysundera HC, Bagai A, Pang J, Kalra S, Džavík V, Bhindi R, Overgaard CB, Vijayaraghavan R. First In-Human Use of a Novel Perfusion Balloon Catheter in the Management of Coronary Perforation. Can J Cardiol 2024; 40:1675-1678. [PMID: 38378081 DOI: 10.1016/j.cjca.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/07/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Vincent Siu
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shane Parfrey
- Scarborough Health Network, Scarborough, Ontario, Canada.
| | - Christopher Li
- Scarborough Health Network, Scarborough, Ontario, Canada
| | - John J Graham
- Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jeffrey Pang
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sanjog Kalra
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Vladimír Džavík
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rahul Bhindi
- Trillium Health Partners, Toronto, Ontario, Canada
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7
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Wang J, Liu Y, Jin GZ. Safety and Efficacy of Polyvinyl Alcohol Granules in Treating Type II and III Coronary Artery Perforation. Int J Gen Med 2024; 17:3663-3670. [PMID: 39193260 PMCID: PMC11348980 DOI: 10.2147/ijgm.s474746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
Objective The success rate of polyvinyl alcohol (PAV) granules in the treatment of coronary artery perforation (CAP) was investigated to determine their safety and efficacy. Methods Forty patients with II and III coronary artery perforations during percutaneous coronary intervention were divided into two groups. One group was only occluded by low pressure balloons (balloon occlusion group), and the other one was occluded with PVA granules during low-pressure balloon dilatation (PVA granules embolization group). Retrospective analysis of clinical data was used to compare the success rate and safety of various methods. Results The balloon embolization group had 16 cases (88.9%) of coronary perforation type II and 2 cases (11.1%) of coronary perforation type III. The PVA granules embolization group had 20 cases (90.9%) of coronary perforation type II and 2 cases (9.1%) of coronary perforation type III. Of the 18 patients in the balloon occlusion group, 13 were immediately occluded, with a success rate of 72.2%, while the remaining 5 required embolization or covered stents. 6 of the 18 patients had pericardial effusion, and two of them underwent pericardiocentesis. Among the 22 patients in the PVA granules embolization group, 21 were immediately blocked, with a 95.5% success rate, while the other was occluded by a covered stent. The results revealed that the success rate of transcatheter closure in the PVA granules embolization group was significantly higher than that in the balloon embolization group, and the risk of pericardial effusion and pericardiocentesis in the PVA granules embolization group was significantly lower than that in the balloon embolization group. Conclusion In comparison to the simple use of low-pressure balloon occlusion, the use of PAV granules in the treatment of II, III coronary artery perforation has a high success rate and safety, and is a viable method for treating coronary artery perforation.
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Affiliation(s)
- Jun Wang
- Department of Cardiology, Hongze District People’s Hospital, Huaian, 223100, People’s Republic of China
| | - Yuan Liu
- Community Health Service Center of Huaihai Road, Nanjing, 210002, People’s Republic of China
| | - Guo-zhen Jin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People’s Republic of China
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8
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Park SM, Choi KC, Lee BH, Yoo SY, Kim CY. Serial Vascular Responses of Balloon-Expandable Stent With Biodegradable Film-Type Graft in a Rabbit Iliac Artery Dissection Model (BioGard Study). Korean Circ J 2024; 54:499-512. [PMID: 39109598 PMCID: PMC11306422 DOI: 10.4070/kcj.2024.0049] [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: 02/01/2024] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Arterial dissection during endovascular therapy rarely occurs but can be lethal. A fabric-based covered graft stents yield poor clinical outcomes. A novel balloon-expandable stent with biodegradable film graft for overcoming these issues was evaluated in a rabbit iliac artery model. METHOD Eighteen rabbits with iliac artery dissections were induced by balloon over-inflation on angiography (Ellis type 2 or 3) and treated using the test device (3.0×24 mm). Subsequently, survived twelve animals underwent histologic examinations and micro-computed tomography (CT) at 0, 2, 4, and 8 weeks and 3, 6, 9, and 12 months and angiography at one-year. RESULTS There were no adverse cardiovascular events during the one-year. Early-stage histologic examination revealed complete sealing of disrupted vessels by the device, exhibiting mural hematoma, peri-stent red thrombi, and dense infiltration of inflammatory cells. Mid- and long-term histologic examination showed patent stents with neointimal hyperplasia over the stents (% area stenosis: 11.8 at 2 weeks, 26.1 at 1 month, 29.7 at 3 months, 49.2 at 9 months, and 51.0 at 1 year), along with mild peri-strut inflammatory response (Grade: 1-2 at mid-term and 0-1 at long-term). The graft film became scarcely visible after six months. Both CT and angiography revealed no instances of thrombotic occlusion or in-stent restenosis (% diameter stenosis: 5.7 at 2 weeks, 12.3 at 1 month, 14.2 at 3 months, 25.1 at 9 months, and 26.6 at 1 year). CONCLUSIONS The novel balloon-expandable stent with a biodegradable film graft demonstrates feasibility in managing severe artery dissection and preventing lethal vascular events in animal model.
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Affiliation(s)
- Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
| | - Kyung-Chan Choi
- Department of Pathology, Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byeong Han Lee
- Laboratory Animal Center, Osong Medical Innovation Foundation, Osong, Korea
| | - Sang Yol Yoo
- Department of Radiology, H Plus Yangji Hospital, Seoul, Korea
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Mishra AK, Bansal V, Kumar RM, Kumar N, Patel N, Mittal A. Outcomes of emergency surgical intervention for complications in the cardiac catheterization laboratory. Indian J Thorac Cardiovasc Surg 2024; 40:444-450. [PMID: 38919180 PMCID: PMC11194233 DOI: 10.1007/s12055-024-01722-9] [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: 12/07/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/27/2024] Open
Abstract
Background In today's era, cardiac catheterization procedures are becoming increasingly safe, but they are still fraught with complications. We aimed to study the outcomes of patients who underwent emergency surgical intervention for complications in the cardiac catheterization laboratory. Methods A retrospective analysis of patients who required emergency surgical management following a complication in the cardiac catheterization laboratory in our institute from July 2017 to July 2022 was done. Result A total of 57 patients out of a total of 52,326 patients (0.1%) were included. The average age of presentation was 10.4 years. Congenital heart disease (CHD) constituted the majority of the cases (28/57-49.1%), coronary artery disease (CAD) constituted 19.3% (11/57), and rheumatic heart disease (RHD) constituted 8.8% (5/57) of the cases. Apart from this, 22.80% patients (13/57) were grouped together in the miscellaneous group. In total, 76.9% (10/13) of these patients had pericardial effusion and they developed a right ventricular (RV) rent following an attempted pigtail drainage. Also, one patient each had a RV rent following an attempted permanent pacemaker implantation for heart block and an endocardial biopsy respectively. One patient had a left bronchial rupture following thoracic endovascular aortic repair (TEVAR) for descending thoracic aorta (DTA) aneurysm. Thirty-day mortality was 7% (4/57), and the mean time of shifting the patients from the catheterization laboratory to the operating room was 8.3 h. Conclusion Cardiac catheterization procedures have become increasingly safe, but complications can still occur, for which the cardiac surgeon should be briefed in a Heart Team meeting before taking up such cases. Even though these complications form a small percentage, the cardiologist should exercise some caution in attempting cases which could have a relatively easier surgical correction.
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Affiliation(s)
- Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitish Kumar
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishit Patel
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Apeksha Mittal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Urban L, Dragula M, John L, Kňazeje M. Percutaneous Coronary Intervention (PCI)-Related Coronary Artery Perforation Permanently Sealed by a Severed Inflated Balloon After Shaft Fracture: A Case Report. Cureus 2024; 16:e60295. [PMID: 38872636 PMCID: PMC11170306 DOI: 10.7759/cureus.60295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Percutaneous coronary intervention (PCI) is an essential modality for the treatment of coronary artery disease. However, rare complications, such as coronary artery perforation and equipment failure, pose significant challenges. This case report describes a unique case of PCI-related coronary artery perforation and a cascade of subsequent complications managed successfully by an unconventional approach. We present a case of an 86-year-old patient who underwent coronary angiography for unstable angina and was treated with implantation of two drug-eluting stents into his right coronary artery (RCA). Implantation of the second stent caused an Ellis grade III perforation. The attempt to seal the perforation with two covered stents failed, the leak persisted, and a balloon had to be reinflated in proximal RCA. However, the patient descending into obstructive shock abruptly flexed his upper extremities breaking off the inflated balloon in proximal RCA, effectively sealing the perforation. Successful pericardiocentesis with drainage of 250 ml of blood stabilized the patient's condition and he regained consciousness. Despite moderate-intensity chest pain and extensive consultation with members of the heart team, the patient refused cardiac surgery opting for a conservative approach. The patient was discharged on post-PCI day 7, eventually resumed a physically active lifestyle, and returned for frequent follow-up visits. This case highlights the challenges in managing rare PCI complications like coronary artery perforation and balloon shaft fracture. It emphasizes the importance of rapid recognition, discusses individual techniques for the management of these complications, and focuses on the value of shared decision-making.
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Affiliation(s)
- Lukáš Urban
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
| | - Milan Dragula
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
| | - Luboš John
- Cardiology, University Hospital Martin, Martin, SVK
- Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, SVK
| | - Miloš Kňazeje
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
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11
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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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Denby K, Zaczkiewicz M, Banthiya S, Mashayekhi K, Khatri J. Understanding large vessel perforation requiring treatment with covered stent implantation: A case series. Catheter Cardiovasc Interv 2024; 103:570-579. [PMID: 38470093 DOI: 10.1002/ccd.30989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
Large vessel perforation during coronary intervention is a rare but potentially fatal complication, often requiring implantation of a covered stent for resolution. While technology is improving, the long-term patency of covered stents is less than drug-eluting stents, and implantation of covered stents should be used sparingly. Large vessel perforations are complex and often the perforation inflow is not located at the site of extravasation seen on angiography. This can lead to geographic miss when implanting covered stents and necessitate the implantation of additional covered stents which increases the risk for short- and long-term complications. We present a case series to further investigate the anatomy and mechanism of large vessel perforations and guidance on effective covered stent implantation.
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Affiliation(s)
- Kara Denby
- Department of Cardiology, Saint Alphonsus Medical Group, Boise, Idaho, USA
| | | | - Sukriti Banthiya
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, Michigan, USA
| | | | - Jaikirshan Khatri
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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13
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Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
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Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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14
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Ruan YD, Han JW. Spontaneous coronary artery rupture after lung cancer surgery: A case report and review of literature. World J Cardiol 2024; 16:92-97. [PMID: 38456070 PMCID: PMC10915888 DOI: 10.4330/wjc.v16.i2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Spontaneous coronary artery rupture (SCAR) is a rare and life-threatening complication after lung cancer surgery. We present a case of SCAR following left upper lobectomy, successfully managed through emergency thoracotomy and coronary artery ligation. CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer. The surgery was performed using single-port video-assisted thoracoscopic surgery, and there were no observed complications during the procedure. However, 19 h after surgery, the patient experienced chest discomfort and subsequently developed severe symptoms, including nausea, vomiting, and a drop in blood pressure. Urgent measures were taken, leading to the diagnosis of SCAR. The patient underwent emergency thoracotomy and coronary artery ligation, successfully stopping the bleeding and stabilizing the condition. Despite postoperative complications, the patient made a successful recovery and was discharged from the hospital. CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery. Immediate thoracotomy has been shown to be a life-saving measure, while stenting is not the preferred initial approach.
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Affiliation(s)
- Ying-Ding Ruan
- Department of Thoracic Surgery, The First People's Hospital of Jiande, Jiande 311600, Zhejiang Province, China
| | - Jian-Wei Han
- Department of Thoracic Surgery, The First People's Hospital of Jiande, Jiande 311600, Zhejiang Province, China.
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15
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Bay B, Kiwus LM, Goßling A, Koester L, Blaum C, Schrage B, Clemmensen P, Blankenberg S, Waldeyer C, Seiffert M, Brunner FJ. Procedural and one-year outcomes of robotic-assisted versus manual percutaneous coronary intervention. EUROINTERVENTION 2024; 20:56-65. [PMID: 38165113 PMCID: PMC10756222 DOI: 10.4244/eij-d-23-00375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (rPCI) has proven to be feasible and safe. Comparative analyses of rPCI versus manual PCI (mPCI) are scarce. AIMS We aimed to investigate procedural aspects and outcomes of rPCI using the second-generation CorPath GRX Vascular Robotic System compared with mPCI in patients with chronic coronary syndrome and non-ST-segment elevation myocardial infarction acute coronary syndrome. METHODS From January to April 2021, 70 patients underwent rPCI at the University Heart & Vascular Center Hamburg-Eppendorf and were recruited into the INTERCATH study. By propensity score matching, a control cohort of 210 patients who underwent mPCI from 2015-2021 was identified. Co-primary endpoints were one-year all-cause mortality and major adverse cardiovascular events (MACE) as a composite of cardiovascular death, unplanned target lesion revascularisation, myocardial infarction, and stroke. RESULTS The median age of the patients (n=280) was 70.7 (25th percentile-75th percentile: 62.0-78.0) years, and 24.6% were female. The Gensini score (28.5 [16.2-48.1] vs 28.0 [15.5-47.0]; p=0.78) was comparable between rPCI versus mPCI. During the PCI procedure, total contrast fluid volume did not differ, whilst longer fluoroscopy times (20.4 min [13.8-27.2] vs 14.4 min [10.4-24.3]; p=0.001) were documented in the rPCI versus mPCI cohort. After 12 months of follow-up, neither all-cause mortality (p=0.22) nor MACE (p=0.25) differed between the groups. CONCLUSIONS rPCI was associated with longer fluoroscopy times compared with mPCI, though without increased use of contrast medium. One-year follow-up revealed no differences in all-cause mortality or MACE, supporting the safety of a robotic-assisted approach.
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Affiliation(s)
- Benjamin Bay
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luisa M Kiwus
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Koester
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Blaum
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Clemmensen
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Sobieszek G, Zięba B, Dworzański W, Celiński R, Barbero U, Opolski MP. Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)-Multicenter Study. J Cardiovasc Dev Dis 2023; 10:496. [PMID: 38132663 PMCID: PMC10743633 DOI: 10.3390/jcdd10120496] [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: 10/24/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Iatrogenic distal coronary artery perforation can be a life-threatening complication. While there are different dedicated devices for the embolization of distal perforations, there are scarce data about the embolization using the fragmented balloon catheter, the so-called cut balloon technique (CBT). METHODS We included consecutive patients with distal coronary perforations treated with CBT in four cardiac centers between 2017 and 2023. Clinical, angiographic and procedural characteristics as well as in-hospital outcomes were recorded. RESULTS Twenty-six patients (68% men, mean age: 71 ± 10.6 years) with 25 distal coronary perforations and one septal collateral perforation were included. Eleven patients (42%) had elective percutaneous coronary intervention, while fifteen patients (58%) were treated for acute coronary syndrome. The site of perforation was most frequently distributed in the left anterior descending artery (40%), followed by the circumflex artery (28%) and right coronary artery (24%). The diameter of balloons for CBT ranged from 1.5 to 4.0 mm, with most balloons (76%) being either 2.0 or 2.5 mm in diameter. Most balloons (88%) were previously used for lesion predilatation. The numbers of cut balloons needed to seal the perforation were 1, 2 and ≥3 in 48%, 20% and 32% of cases, respectively. The in-hospital prognosis was favorable, with cardiac tamponade requiring pericardiocentesis in only four (16%) patients. Neither emergency surgery nor cardiac death occurred. CONCLUSIONS CBT is a safe, efficient and easy-to-implement technique for the embolization of coronary perforations. Most distal coronary perforations can be sealed with one or two fragments of cut balloons, obviating the need for additional devices.
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Affiliation(s)
| | - Bartosz Zięba
- Department of Cardiology, 1st Military Hospital, 20-049 Lublin, Poland;
| | | | - Rafał Celiński
- Department of Cardiology, Specialistic Hospital, 22-100 Chełm, Poland;
| | - Umberto Barbero
- Cardiology Division, Santissima Annunziata Hospital, 12038 Savigliano, Italy;
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland;
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17
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Majeed H, Blankenship JC. Ellis type 4 coronary artery perforation during percutaneous coronary intervention: Case series and review. Catheter Cardiovasc Interv 2023; 102:1252-1258. [PMID: 37948439 DOI: 10.1002/ccd.30873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/04/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
Ellis type 4 coronary artery perforation (CAP4), also referred to as Ellis type 3 cavity-spilling perforation, is a rare but life-threatening complication of percutaneous coronary intervention characterized by extravasation of blood into a cardiac chamber, anatomic cavity, or coronary sinus or vessel. CAP4 is uncommon, accounting for 1.9% to 3.0% of all CAP. Only 11 cases of CAP4 have been reported in detail; we report an additional two cases and review prior reports of this rare complication. Our first case highlights a patient with chronic anginal symptoms due to a 75% concentric stenotic lesion in the mid-LAD. Revascularization was complicated by perforation during pre-dilation with robust contrast extravasation into the left ventricle. Successful postperforation hemostasis was achieved with heparin reversal and covered stent placement. The second case demonstrates another major mechanism of CAP4: wire perforation. During intervention, the absence of blood flow distal to the lesion in the setting of an ST segment elevation myocardial infarction obscured the course of the nonhydrophilic floppy wire leading to perforation that was managed conservatively. In our scoping review, we found that the majority of CAP4 occurred in the LAD. The most frequently involved cavity was the left ventricle-other cavities involved were the right ventricle and coronary veins. Common etiologies of CAP4 included guidewire perforation (62%) and balloon dilation (31%). Perforation was managed with reversal of anticoagulation in 46% of cases, prolonged balloon inflation in 54% of cases, and covered stent deployment in 15% of cases. No patients required surgical repair or pericardiocentesis and perforations were successfully sealed in all cases. In-hospital mortality was 0%.
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Affiliation(s)
- Harris Majeed
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - James C Blankenship
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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18
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Kuno T, Ohata T, Nakamaru R, Sawano M, Kodaira M, Numasawa Y, Ueda I, Suzuki M, Noma S, Fukuda K, Kohsaka S. Long-term outcomes of periprocedural coronary dissection and perforation for patients undergoing percutaneous coronary intervention in a Japanese multicenter registry. Sci Rep 2023; 13:20318. [PMID: 37985895 PMCID: PMC10662469 DOI: 10.1038/s41598-023-47444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
Long-term outcomes of iatrogenic coronary dissection and perforation in patients undergoing percutaneous coronary intervention (PCI) remains under-investigated. We analyzed 8,721 consecutive patients discharged after PCI between 2008 and 2019 from Keio Cardiovascular (KiCS) PCI multicenter prospective registry in the Tokyo metropolitan area. Significant coronary dissection was defined as persistent contrast medium extravasation or spiral or persistent filling defects with complete distal and impaired flow. The primary outcome was a composite of all-cause death, acute coronary syndrome, heart failure, bleeding, stroke requiring admission, and coronary artery bypass grafting two years after discharge. We used a multivariable Cox hazard regression model to assess the effects of these complications. Among the patients, 68 (0.78%) had significant coronary dissections, and 61 (0.70%) had coronary perforations at the index PCI. Patients with significant coronary dissection had higher rates of the primary endpoint and heart failure than those without (25.0% versus 14.3%, P = 0.02; 10.3% versus 4.2%, P = 0.03); there were no significant differences in the primary outcomes between the patients with and without coronary perforation (i.e., primary outcome: 8.2% versus 14.5%, P = 0.23) at the two-year follow-up. After adjustments, patients with coronary dissection had a significantly higher rate of the primary endpoint than those without (HR 1.70, 95% CI 1.02-2.84; P = 0.04), but there was no significant difference in the primary endpoint between the patients with and without coronary perforation (HR 0.51, 95% CI 0.21-1.23; P = 0.13). For patients undergoing PCI, significant coronary dissection was associated with poor long-term outcomes, including heart failure readmission.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210Th St, New York, NY, 10467-2401, USA.
- Division of Cardiology, Jacobi Medical Center, New York, USA.
| | - Takanori Ohata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, USA
| | - Masaki Kodaira
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Wako, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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19
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An W, Ye J, Han B, Wang X, Han C, Gao J, Liu Z. Efficacy and safety of self-made covered coronary stent in the treatment of coronary artery perforation. BMC Cardiovasc Disord 2023; 23:537. [PMID: 37923982 PMCID: PMC10625290 DOI: 10.1186/s12872-023-03575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE To observe the efficacy and safety of self-made covered coronary stent in the treatment of coronary artery perforation. METHODS Covered coronary stent was prepared by wrapping 3 M film on the surface of coronary stents. The beagle dogs were divided into control group and experimental group. A drug-eluting stent (DES) was implanted in the control group. The covered stent was applied to block the coronary branches of beagle dogs. The CaIMR value after stent placement was calculated by FlashAngio software. The effect of blocking the coronary branches on blood flow was observed by coronary angiography (CAG). The condition of the implanted stent was observed by optical coherence tomography (OCT), and the histopathologic examination of the coronary vessel implanted stent was performed by HE staining. RESULTS The best number of layers was 2. Compared with the control group, the CaIMR of the experimental group increased (p < 0.05). A lot of in-stent thrombosis were found in the experimental group and obvious blood flow obstruction during follow-up. HE staining showed that stents implanted in the two groups adhered well to the wall of the blood vessel, but in-stent thrombosis and intimal hyperplasia were founded in the experimental group, while the in-stent restenosis was not founded. CONCLUSION The self-made coronary covered stent can effectively block the leakage caused by coronary perforation, but the stent endothelialization is poor, which easily causes stent thrombosis and restenosis, so it is not recommended as a routine remedy.
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Affiliation(s)
- Wen An
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Jian Ye
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, People's Republic of China
| | - Bingyu Han
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Xu Wang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Chao Han
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Junqing Gao
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China.
| | - Zongjun Liu
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China.
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20
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Ayoub M, Corpataux N, Tajti P, Behnes M, Schupp T, Forner J, Akin I, Westermann D, Rudolph V, Mashayekhi K. A Novel Strategy for Emergency Treatment of Coronary Perforations by Placing a Drug-Eluting Stent before Sealing off the Leakage with a Covered Stent to Improve Long-Term Outcomes in Patients with Coronary Artery Perforations. J Pers Med 2023; 13:1542. [PMID: 38003857 PMCID: PMC10672714 DOI: 10.3390/jpm13111542] [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: 09/11/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
We aimed to investigate the safety, feasibility, and long-term results of drug-eluting stent implantation before covered stents for treating coronary artery perforation (CAP). Between 2015 and 2020, 12,733 patients undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. The primary endpoint was 1-year target lesion revascularization (TLR), whereas secondary endpoints included the rate of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death at 1 year. A total of 159 patients with CAP were identified during the study period, of whom 47.2% (n = 75) were treated with a covered stent (CS group) because of complex and/or severe CAP and 84 (52.8%) without (non-CS group). In the majority of patients, emergency drug-eluting stent placement before covered stent implantation was feasible (n = 69, 82%). There were no significant differences among patients treated with or without a covered stent in terms of primary or secondary clinical endpoints: a similar rate of TLR (18.67% vs. 21.43%, p = 0.6646), MACCE (25.33% vs. 22.62%, p = 0.6887), and 1-year mortality (12.00% vs. 11.90%, p = 0.9853) were identified comparing cases with covered stent implantation and without. In conclusion, our study implicates that the use of covered stents for sealing coronary perforation might not impact the 1-year clinical outcome if used properly. Moreover, the emergent use of drug-eluting stents before covered stent implantation in CAP is a safe and effective method to avoid target lesion revascularization in patients treated with covered stents.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Division of Cardiology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Péter Tajti
- Division of Interventional Cardiology, Gottsegen Gyorgy National Cardiovascular Center, 1096 Budapest, Hungary
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Jan Forner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
- Faculty of Medicine Göttingen, University of Göttingen, 37077 Göttingen, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Dirk Westermann
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
- Clinic of Internal Medicine and Cardiology, Heart Center Lahr, 77933 Lahr, Germany
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21
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Yildiz BS, Gunduz R, Ozgur S, Cizgici AY, Ozdemir IH. Clinical Outcomes of Comparison Between Type III Coronary Artery Perforation (CAP) and non-CAP Acute Coronary Syndrome Patients During 3-Year Follow-up. Angiology 2023:33197231200029. [PMID: 37694576 DOI: 10.1177/00033197231200029] [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: 09/12/2023]
Abstract
Coronary artery perforation (CAP) is a potentially fatal complication of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). This study aimed to investigate in-hospital, 1-year, and 3-year clinical outcomes of type III CAP during PCI in patients with ACS. The study retrospectively evaluated 118 patients with CAP and 43,226 case-control patients. Clinical, angiographic, and procedural characteristics, management, and outcomes were analyzed retrospectively at 1-year and 3-year follow-ups. The mean age of the patients was 66.5 ± 11.9 years (61.8% males). There was no significant difference in hospital mortality between the type III CAP and non-CAP groups. The all-cause mortality was 33.3% in the CAP group vs 1.8% in the non-CAP group at 1 year, and 28.3% in CAP group vs 6.9% in non-CAP group at 3 years (p = .001 for both comparisons). The procedural, clinical, and 1 and 3-year outcomes of type III CAP showed a relatively high risk of myocardial infarction, coronary artery bypass graft, cerebrovascular event, stent thrombosis, and major bleeding at the 1 and 3-year follow-ups. In addition, non-CAP ACS patients had better survival (log-rank: p < .001, 34.29 months 95% Confidence Interval [33.58-35.00]) than type III CAP ACS patients (29.53 months 95% Confidence Interval [27.28-31.78]) at the 3-year follow-up visit.
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Affiliation(s)
- Bekir S Yildiz
- Department of Cardiology, Celal Bayar University, Manisa, Turkey
| | - Ramazan Gunduz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Ahmet Y Cizgici
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training Research Hospital, Istanbul, Turkey
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22
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Areiza LA, Rodriguez JF. Successful Percutaneous Coronary Intervention in Chronic Total Occlusion after Coronary Perforation. Case Rep Cardiol 2023; 2023:6640439. [PMID: 37680568 PMCID: PMC10482517 DOI: 10.1155/2023/6640439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
Coronary chronic total occlusions are challenging lesions with high rates of complications related to percutaneous intervention. We describe a successful angioplasty in a patient with a recent coronary perforation, using multiple techniques, such as stick and swap with Stingray, subintimal transcatheter withdrawal, and investment.
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Affiliation(s)
- Luis A. Areiza
- Department of Interventional Cardiology, HUM Mederi, Bogota, Colombia
| | - Juan F. Rodriguez
- Department of Interventional Cardiology, HUM Mederi, Bogota, Colombia
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Movahed MR. Benign Chronic Mid Left Anterior Descending Artery Perforation in the Setting of Coronary Intervention with a Large Fistula Formation Into the Right Ventricular Cavity. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S213-S215. [PMID: 35842401 DOI: 10.1016/j.carrev.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
Coronary perforations occurring during percutaneous coronary intervention can be life-threatening and usually requires immediate intervention to seal the perforation. Here, a case of chronic large persistent left anterior descending artery perforation into the right ventricle that was left alone without any significant clinical sequela is presented. This case is the first case report of this interesting benign complication followed by a review of the literature of reported cases with coronary perforation in any cardiac chamber.
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Affiliation(s)
- Mohammad Reza Movahed
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ1, United States of America; Department of Medicine, University of Arizona, Phoenix, AZ 2, United States of America.
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Hu Y, Liu J, Qian J, Lu H, Ge J. Unveiling a rare case: Cardiac rupture secondary to acute occlusion of the distal left circumflex artery detected by contrast-enhanced spiral CT. Heliyon 2023; 9:e18460. [PMID: 37576269 PMCID: PMC10415615 DOI: 10.1016/j.heliyon.2023.e18460] [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: 03/26/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
A 79-year-old female patient was admitted to the hospital due to intense chest pain. Emergency percutaneous coronary intervention (PCI) revealed an occlusion in the distal portion of the left circumflex artery (LCx). The patient suffered from cardiac rupture, an uncommon yet extremely perilous condition, within 30 minutes following the procedure. This was verified through a computed tomography angiography (CTA) scan and bedside echocardiography. The etiology of cardiac rupture remains elusive, yet potential factors such as the patient's age, gender, initial acute myocardial infarction (AMI), and single-vessel disease without collateral circulation may be linked to this occurrence. This case report emphasizes that occluded tiny distal coronary arteries can also induce cardiac rupture and that a sufficient level of suspicion for the diagnosis of cardiac rupture should be raised when adequate fluid resuscitation fails to alleviate hypotension. Additionally, contrast-enhanced spiral computed tomography (CESCT) is highly effective in revealing certain pathological features associated with cardiac rupture.
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Affiliation(s)
- Yiqing Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
- Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
- Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Hao Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
- Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
- Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
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Achim A, Harb S, Toth GG, Krivoshei L, Leibundgut G. Conservative Treatment for Cavity Spilling Coronary Perforations. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S209-S212. [PMID: 35963835 DOI: 10.1016/j.carrev.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
Abstract
Coronary perforation leading to shunting to other cardiac chambers is a rare complication of percutaneous coronary intervention (PCI), and most cases reported aggressive treatment with either a covered stent, coiling, or protamine injection. We report herein two cases, one of a fairly large cavity-spilling perforation of the left anterior descending coronary artery into the right ventricle and one spilling in the coronary vein. Both iatrogenic shunts were treated conservatively, and angiographic follow-up showed spontaneous resolution, suggesting that the outcome in this type of perforation may be favorable with conservative therapy. We also propose a management strategy on how to differentiate such contrast extravasations, find which cavity is communicating with the vessel and when to intervene more decisively. SOCIAL MEDIA ABSTRACT: We report herein two "fortunate" perforations, one of a fairly large cavity-spilling perforation from the left anterior descending coronary artery into the right ventricle and one spilling in the coronary vein. The angiographic follow-up showed spontaneous healing due to spilling in low-pressure cavities. A "no-touch" strategy is preferred if the patient remains asymptomatic and the pericardium free of fluid.
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Affiliation(s)
- Alexandru Achim
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland; University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Stefan Harb
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Gabor G Toth
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Lian Krivoshei
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
| | - Gregor Leibundgut
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland.
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Voll F, Koch T, Tölg R, Lenz T, Schroeter M, Lenders G, Hokken R, Cassese S, Xhepa E, Schunkert H, Kastrati A, Kufner S. Clinical Safety and Efficacy of New-Generation Single-Layer Polytetrafluorethylene Covered Coronary Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:30-36. [PMID: 36822974 DOI: 10.1016/j.carrev.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Early-generation "sandwich-design" polytetrafluorethylene (PTFE) covered coronary stents (CS) are associated with a high frequency of adverse events. New-generation single layer PTFE-CS offers the potential to enhanced procedural efficacy and improves clinical safety. Data from a dedicated study, concerning outcomes after treatment with single-layer PTFE-CS in patients undergoing percutaneous coronary intervention are scant. METHODS This is a retrospective multicenter registry including 30 patients undergoing implantation of 39 single-layer PTFE-CS (BeGraft-coronary Stent Graft System, Bentley InnoMed GmbH, Hechingen, Germany) in native coronary arteries or saphenous bypass grafts, in 3 centers in Europe, between May 2013 and May 2019. Endpoints of interest were procedural success (placement of covered stent), binary-angiographic restenosis (BAR), percent diameter stenosis (% DS) and late-lumen loss at 6-8 months follow-up angiography, rates of target lesion revascularization (TLR), myocardial infarction (MI), stent thrombosis (ST) and mortality at 12 months. RESULTS 28 patients underwent implantation of 37 CS due to coronary artery perforation 2 patients due to coronary artery aneurysm. Technical success was achieved in all patients (100 %). More than one stent was implanted in 7 patients (25 %) all in the perforation group. Follow-up angiography was available in 23 patients (77 %) showing favorable results: BAR = 21.8 %, %DS = 30.3 ± 27.5; LLL = 0.16 ± 0.81 mm. At 12 months all patients were alive, rates of TLR were low (3 patients, 10.0 %), there was one case of late stent thrombosis (3.3 %) and one MI (3.3 %). CONCLUSIONS In this dedicated study, implantation of a new single layer PTFE-CS for the treatment of native coronary arteries or saphenous vein grafts after perforation or due to aneurysm showed high technical success rates and favorable angiographic and clinical efficacy. Clinical safety outcomes are encouraging, but larger prospective studies are needed to determine long-term safety of this device.
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Affiliation(s)
- Felix Voll
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ralph Tölg
- Herzzentrum der Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Tobias Lenz
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Mira Schroeter
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | | | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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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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Leone PP, Calò L, Donahue M, Gasparini G. Acute coronary complications in chronic total occlusion interventions. Eur Heart J Suppl 2023; 25:C96-C105. [PMID: 37125294 PMCID: PMC10132573 DOI: 10.1093/eurheartjsupp/suad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Chronic total occlusion (CTO) interventions are among the most complex procedures within the panorama of percutaneous coronary intervention (PCI). Awareness of potential complications, adequate procedural planning in order to avoid them, and prompt recognition and management should any occur are at the cornerstone of a successful CTO programme. Complications can be acute or late after the procedure and can be cardiac or non-cardiac. Acute cardiac complications can occur directly at the coronary artery level or can have other strictly non-coronary manifestations, such as hypotension, myocardial infarction, arrhythmias, or tamponade. In this review, we focus on acute coronary complications of CTO PCI, in particular their causes, prevention, and management strategies.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano-Milan, Italy
- Division of Cardiology, Montefiore Medical Center, 111 E 210th St, The Bronx, NY 10467, USA
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina, 1049, 00169 Rome, Italy
| | - Michael Donahue
- Department of Cardiology, Policlinico Casilino, Via Casilina, 1049, 00169 Rome, Italy
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Strycek M, Jaworski L, Polasek R, Tomasov P. Coronary artery perforation successfully treated with a second drug-eluting stent. J Int Med Res 2023; 51:3000605231174998. [PMID: 37235714 DOI: 10.1177/03000605231174998] [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: 05/28/2023] Open
Abstract
A coronary artery perforation is a rare, but potentially lethal, complication of percutaneous coronary intervention. We present a case of massive main vessel coronary perforation of the right coronary artery in a patient with acute ST segment elevation myocardial infarction, which was successfully treated with a second drug-eluting stent. This uncommon therapeutic approach was used to preserve flow to the large side branch. Early recognition, rapid balloon re-inflation at the perforation site and a "ping-pong" guiding technique allowed us to prepare the optimal strategy and to treat the perforation without developing cardiac tamponade.
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Affiliation(s)
- Matej Strycek
- Cardiology Department, Liberec Regional Hospital, Czech Republic
| | - Lukas Jaworski
- Cardiology Department, Liberec Regional Hospital, Czech Republic
| | - Rostislav Polasek
- Cardiology Department, Liberec Regional Hospital, Czech Republic
- Faculty of Health Studies, The Technical University of Liberec, Czech Republic
| | - Pavol Tomasov
- Cardiology Department, Liberec Regional Hospital, Czech Republic
- Faculty of Health Studies, The Technical University of Liberec, Czech Republic
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30
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Takagi K, Yoshida R, Fujita T, Noguchi T. Bail-Out Techniques in Percutaneous Intervention for Ellis Grade III Coronary Perforation in Left Main Distal Bifurcation Lesions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100609. [PMID: 39130718 PMCID: PMC11307895 DOI: 10.1016/j.jscai.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 08/13/2024]
Abstract
The left main (LM) coronary artery stenosis is associated with high morbidity and mortality and has traditionally been treated with coronary artery bypass grafting. However, in recent years, advancements in device technology and adjunctive pharmacotherapy have led to the widespread use of percutaneous coronary intervention (PCI) as a treatment for unprotected LM lesions. Despite this, LM lesions are often complex, involving distal bifurcation and heavy calcification, which increases the risk of coronary perforation (CP) during PCI. In addition, the use of rotational or orbital atherectomy in severely calcified LM bifurcation lesions carries a higher risk of complications and in-hospital mortality than that in non-LM lesions. CP is a rare but potentially fatal complication of PCI, particularly in cases of Ellis grade III (CP-G3), with a high rate of cardiac tamponade and mortality. The management of CP-G3 in LM distal bifurcation lesions is challenging and requires specialized techniques. This article presents a flowchart of bail-out strategies for CP-G3 in LM distal bifurcation lesions and provides detailed procedures for each technique. Furthermore, we highlight the challenges and limitations of each technique, requiring careful management when CP-G3 occurs in LM distal bifurcation lesions.
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Affiliation(s)
- Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ruka Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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da Silva ACB, de Paula JET, Campos CM, Ribeiro MH, Martins E, Oliveira MDP, Côrtes LA, Abelin AP, Zukowski CN, Martinelli GC, de Brito FS, Muniz AJ, Cantarelli MJDC, de Andrade PB, Medeiros CR, Falcão BDAA, Fuchs FC, Silva LS, Fattah T, Degrazia RC, Mangione JA, Bezerra CG, Baradel S, Silveira JB, Ybarra LF, Weillenmann D, Gottschall C, Lemke V, da Silva FR, Schmidt MM, Belli KC, de Oliveira PP, de Quadros AS. Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry. Arq Bras Cardiol 2023; 120:e20210462. [PMID: 37132671 PMCID: PMC10263433 DOI: 10.36660/abc.20210462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. OBJECTIVES To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. METHODS Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. RESULTS Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. CONCLUSIONS CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.
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Affiliation(s)
| | - João Eduardo Tinoco de Paula
- Instituto Cardiovascular de LinharesUNICORLinharesESBrasilInstituto Cardiovascular de Linhares UNICOR, Linhares, ES – Brasil
| | - Carlos M. Campos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | | | - Evandro Martins
- Santa Casa de MisericórdiaMaceióALBrasilSanta Casa de Misericórdia, Maceió, AL – Brasil
| | - Marcos Danillo Peixoto Oliveira
- Hospital São PauloEscola Paulista de MedicinaUNIFESPSão PauloSPBrasilHospital São Paulo – Escola Paulista de Medicina – UNIFESP, São Paulo, SP – Brasil
| | - Leandro Assumpção Côrtes
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Aníbal Pereira Abelin
- Instituto do Coração de Santa MariaSanta MariaRSBrasilInstituto do Coração de Santa Maria (ICOR), Santa Maria, RS – Brasil
| | | | - Gustavo Cervino Martinelli
- Hospital Santa IzabelSanta Casa Misericórdia de SalvadorSalvadorBABrasilHospital Santa Izabel Santa Casa Misericórdia de Salvador, Salvador, BA – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital São CamiloSão PauloSPBrasilHospital São Camilo, São Paulo, SP – Brasil
| | - Antônio José Muniz
- Santa Casa de Misericórdia Juiz de ForaJuiz de ForaMGBrasilSanta Casa de Misericórdia Juiz de Fora, Juiz de Fora, MG – Brasil
| | | | | | | | | | - Felipe Costa Fuchs
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
| | | | - Tammuz Fattah
- Instituto de Cardiologia do Estado de Santa CatarinaSão JoseSCBrasilInstituto de Cardiologia do Estado de Santa Catarina, São Jose, SC – Brasil
| | - Ramiro Caldas Degrazia
- Hospital Círculo Operário CaxienseCaxias do SulRSBrasilHospital Círculo Operário Caxiense, Caxias do Sul, RS – Brasil
- Hospital Nossa Senhora do PompeiaSalvadorBABrasilHospital Nossa Senhora do Pompeia, Salvador, BA – Brasil
- Hospital UnimedRio de JaneiroRJBrasilHospital Unimed, Rio de Janeiro, RJ – Brasil
| | - José Armando Mangione
- Beneficência Portuguesa de São PauloSão PauloSPBrasilBeneficência Portuguesa de São Paulo, São Paulo, SP – Brasil
| | - Cristiano Guedes Bezerra
- Rede D’OrHospitais Aliança, São Rafael e CardioPulmonarSalvadorBABrasilRede D’Or – Hospitais Aliança, São Rafael e CardioPulmonar, Salvador, BA – Brasil
| | - Sandra Baradel
- Sociedade Brasileira de Hemodinâmica e Cardiologia IntervencionistaSão PauloSPBrasilSociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, São Paulo, SP – Brasil
| | - João Brum Silveira
- Centro Hospitalar e Universitário do PortoHospital Santo AntôniPortoPortugalCentro Hospitalar e Universitário do Porto, Hospital Santo Antônio, Porto – Portugal
| | - Luiz Fernando Ybarra
- London Health Sciences CentreSchulich School of Medicine and DentistryWestern UniversityOntarioCanadáLondon Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, Ontario – Canadá
| | | | - Carlos Gottschall
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Viviana Lemke
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Franciele Rosa da Silva
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Marcia Moura Schmidt
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Karlyse Claudino Belli
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Pedro Piccaro de Oliveira
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
| | - Alexandre Schaan de Quadros
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
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Scalamogna M, Abdel-Wahab M, Mashayekhi K, Fusaro M, Leistner DM, Ayoub M, Xhepa E, Joner M, Kastrati A, Cassese S, Rheude T. Randomized ComparIson of Strategies to PrepAre SeveRely CALCified Coronary Lesions 2: Design and Rationale of the ISAR-CALC 2 Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:22-27. [PMID: 36609101 DOI: 10.1016/j.carrev.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The percutaneous treatment of severely calcified coronary lesions has been associated with lower performance of coronary stents and poor clinical long-term outcomes. Adequate lesion preparation before stent implantation is of paramount importance to minimize the risk of stent failure. Balloon-based techniques for lesion preparation have been the subject of numerous investigations, albeit comparative data from randomized trials are scarce. STUDY DESIGN AND OBJECTIVES The ISAR-CALC 2 (ClinicalTrials.gov: NCT05072730) is an investigator-initiated, prospective, randomized, multicentre, assessors-blind, open-label trial designed to compare a lesion preparation strategy with either super high-pressure balloon or intravascular lithotripsy (IVL) before drug-eluting stent (DES) implantation in patients with severely calcified, undilatable coronary lesions. In total, 80 patients are required for trial completion. The primary endpoint will be final angiographic minimal lumen diameter (MLD) after stent implantation. Key secondary endpoints include stent expansion assessed by optical coherence tomography (OCT), procedural and strategy success, need for complementary lesion preparation with rotational atherectomy, acute lumen gain, and major adverse cardiac events up to 30-day follow-up. CONCLUSIONS The ISAR-CALC 2 trial aims to demonstrate the superiority of a lesion preparation strategy with a super high-pressure balloon as compared with intravascular lithotripsy prior to DES implantation in patients with severely calcified undilatable coronary lesions.
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Affiliation(s)
- Maria Scalamogna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Kambis Mashayekhi
- Klinik für Innere Medizin und Kardiologie, Herzzentrum Lahr, Germany
| | - Massimiliano Fusaro
- Klinik für Kardiologie und Angiologie, Zollernalb Klinikum, Albstadt, Germany
| | - David M Leistner
- Medizinische Klinik 3 - Kardiologie, Angiologie, Universitätsklinikum Frankfurt/Main, Frankfurt, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt, Germany
| | - Mohamed Ayoub
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Mangieri A, Nerla R, Castriota F, Reimers B, Regazzoli D, Leone PP, Gasparini GL, Khokhar AA, Laricchia A, Giannini F, Casale F, Bezzeccheri A, Briguori C, Colombo A. Cutting balloon to optimize predilation for stent implantation: The COPS randomized trial. Catheter Cardiovasc Interv 2023; 101:798-805. [PMID: 36841945 DOI: 10.1002/ccd.30603] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES The objective of this study is to investigate the use of cutting balloon (CB) inflated at high pressure compared with noncompliant balloon (NCB) for the treatment of calcified coronary lesions. BACKGROUND No data are available regarding the safety and efficacy of CB inflated at high pressure in coronary artery calcifications. METHODS Patients with calcified lesions (more than 100° of calcium demonstrated at baseline intravascular ultrasound) were randomized. Primary endpoint of the study was the final minimal stent area (MSA) and stent symmetry in the calcific segment. Secondary endpoints included rate of device failure and the 1-year rate of target lesion revascularization, target vessel revascularization, and major adverse cardiovascular events. RESULTS From September 2019 to June 2021, a total of 100 patients were included and randomized; 13 patients were excluded for major protocol deviations. Lesions were complex (type B2/C n = 61 [71.2%]) with a mean arch of calcium of 266 ± 84°, a calcium length of 12 ± 6.6 mm. CB was inflated at comparable atmospheres when compared with NCB (18.3 ± 5 vs. 19 ± 4.5, p = 0.46). In the per-protocol population, the final MSA at the level of the calcium site was significantly higher in the CB group (8.1 ± 2 vs. 7.3 ± 2.1, p = 0.035) with a higher eccentricity index achieved in the CB group (0.84 ± 0.07 vs. 0.8 ± 0.08, p = 0.013). Three device failure occurred in the CB group. One-year follow-up outcomes were comparable. CONCLUSIONS Treatment of calcified lesions with high-pressure CB has a good safety profile and is associated with a larger MSA and higher eccentricity of the stent at the level of the calcium site compared with NCB.
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Affiliation(s)
- Antonio Mangieri
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Roberto Nerla
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Fausto Castriota
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Bernhard Reimers
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Damiano Regazzoli
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Pier P Leone
- Department of Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | | | - Arif A Khokhar
- Department of Cardio-Thoracic Cardiology Service, Imperial College Healthcare NHS Trust, London, UK
| | | | - Francesco Giannini
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Fulvio Casale
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | | | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Cardiology Cardio Center IRCCS, Humanitas Research Hospital, Rozzana, Italy
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Kurata N, Iida O, Asai M, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Hata Y, Toyoshima T, Higashino N, Nakao S, Mano T. Factors in Sufficient Endovascular Vessel Preparation for Severely Calcified Femoropopliteal Lesions. Circ J 2023; 87:424-431. [PMID: 36567110 DOI: 10.1253/circj.cj-22-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vessel preparation for endovascular treatment (EVT) is important but because the contributory factors for favorable outcomes are not yet known, we conducted the present study to elucidate the factors associated with sufficient vessel preparation for severely calcified femoropopliteal (FP) lesions. METHODS AND RESULTS This was a single-center retrospective observational study of 97 patients (mean age, 75±8 years, 76% male) with 106 de novo severely calcified FP lesions who underwent EVT under intravascular ultrasound (IVUS) evaluation. The lesion definition was 360° of superficial calcification on IVUS. The primary outcome measure was sufficient vessel preparation, which was defined as successful cracking of severely calcified lesions evaluated by IVUS after predilation. The mean lesion length was 200±103 mm, and chronic total occlusion was present in 38% of patients. According to the greater difference between the preballoon size and the lumen diameter of the severely calcified lesion, the frequency of sufficient vessel preparation increased (odds ratio, 4.68; 95% confidence interval, 2.09-10.49; P<0.01). Balloon type (noncompliant, P=0.80; scoring: P=0.25) and pressure (P=0.27) were non-contributory. CONCLUSIONS The difference between the lumen diameter at the severely calcified FP lesion site and the preballoon dilatation diameter was the sole factor contributing to sufficient vessel preparation.
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Affiliation(s)
- Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center
| | | | | | | | | | | | | | | | | | - Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center
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Nguyen DD, Gosch KL, El‐Zein R, Chan PS, Lombardi WL, Karmpaliotis D, Spertus JA, Wyman RM, Nicholson WJ, Moses JW, Grantham JA, Salisbury AC. Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Heart Assoc 2023; 12:e027915. [PMID: 36718862 PMCID: PMC9973646 DOI: 10.1161/jaha.122.027915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023]
Abstract
Background Although chronic total occlusions (CTOs) are common in older adults, they are less likely to be offered CTO percutaneous coronary intervention for angina relief than younger adults. The health status impact of CTO percutaneous coronary intervention in adults aged ≥75 years has not been studied. We sought to compare technical success rates and angina-related health status outcomes at 12 months between adults aged ≥75 and <75 years in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) registry. Methods and Results Angina-related health status was assessed with the Seattle Angina Questionnaire (score range 0-100, higher scores denote less angina). Technical success rates were compared using hierarchical modified Poisson regression, and 12-month health status was compared using hierarchical multivariable linear regression between adults aged ≥75 and <75 years. Among 1000 participants, 19.8% were ≥75 years with a mean age of 79.5±4.1 years. Age ≥75 years was associated with a lower likelihood of technical success (adjusted risk ratio=0.92 [95% CI, 0.86-0.99; P=0.02]) and numerically higher rates of in-hospital major adverse cardiovascular events (9.1% versus 5.9%, P=0.10). There was no difference in Seattle Angina Questionnaire Summary Score at 12 months between adults aged ≥75 and <75 years (adjusted difference=0.9 [95% CI, -1.4 to 3.1; P=0.44]). Conclusions Despite modestly lower success rates and higher complication rates, adults aged ≥75 years experienced angina-related health status benefits after CTO-percutaneous coronary intervention that were similar in magnitude to adults aged <75 years. CTO percutaneous coronary intervention should not be withheld based on age alone in otherwise appropriate candidates.
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Affiliation(s)
- Dan D. Nguyen
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
| | | | - Rayan El‐Zein
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
| | - Paul S. Chan
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
| | | | | | - John A. Spertus
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
| | | | | | - Jeffrey W. Moses
- Columbia University Medical CenterNew YorkNY
- Saint Francis Heart CenterRoslynNY
| | - J. Aaron Grantham
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
| | - Adam C. Salisbury
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri‐Kansas CityKansas CityMO
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Seiler T, Attinger-Toller A, Cioffi GM, Madanchi M, Teufer M, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Bossard M, Cuculi F. Treatment of In-Stent Restenosis Using a Dedicated Super High-Pressure Balloon. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:29-35. [PMID: 36085285 DOI: 10.1016/j.carrev.2022.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment of in-stent restenosis (ISR) is challenging and treatment failure rate remains high. Correction of stent under-expansion and neointimal compression using the twin-layer OPN™ highly non-compliant balloon (NCB) at high pressure (>30 atm) may lead to increased luminal gain and thus better clinical outcomes. We evaluated periprocedural safety and clinical long-term outcomes after ISR treatment using the OPN™ NCB in a real-world population. METHODS From an ongoing registry, consecutive ISR patients treated with the OPN™ NCB at a tertiary cardiology center in Switzerland were analyzed. We evaluated procedural efficacy, periprocedural complications, target lesion/vessel failure (TLF/TVF), and major adverse cardiovascular events (MACE). RESULTS Totally, 208 ISR lesions were treated in 188 patients (mean age 68 ± 13 years, 78 % males). Most lesions were moderately to heavily calcified (89 %), the majority (70.2 %) had complex lesion characteristics (AHA Type B2/C lesions) and 50.5 % were non-focal ISR lesions. After ISR treatment using high pressure pre- and post-dilatation (mean pressure 33 ± 6 atm) with the OPN™ NCB device, the rate of major complications was low (0.96 % coronary perforation, 4 % major dissections, 1.9 % no-reflow and 0.5 % acute vessel closure). At 1-year follow-up, MACE occurred in 19.7 %; 15.4 % patients had TVF; MI and stent thrombosis was found in 5.9 % and 2.1 % of all patients, respectively; and 5 patients died. CONCLUSIONS For ISR treatment, using the super non-compliant OPN™ balloon at very high pressures is safe. Moreover, its use might lead to a low rate of TLF/TVF during long-term follow-up, but this requires further evaluation in dedicated comparative trials.
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Affiliation(s)
- Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Mario Teufer
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland; Medical School, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland.
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Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions. J Interv Cardiol 2022; 2022:2593189. [PMID: 36636261 PMCID: PMC9810405 DOI: 10.1155/2022/2593189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/28/2021] [Accepted: 12/03/2022] [Indexed: 12/28/2022] Open
Abstract
Background The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear. Objective To investigate in-hospital and long-term outcomes after RA for CTO compared to non-CTO calcified lesions. Moreover, this report evaluates the role of the elective RA approach in calcified CTOs. Methods and Results This study enrolled 812 patients (869 lesions; CTO, n = 80 versus non-CTO, n = 789). The mean age of the study population was 73.1 ± 8.6 years, the baseline characteristics were comparable in both groups. Balloon-resistant CTO lesions represented the main indication for RA in CTO patients (61.2%). The mean J-CTO score was 2.42 ± 0.95. The angiographic success rate was lower in CTO patients (88.8% vs 94.9%; p = 0.022). In-hospital major adverse cardiac events (MACE) rate was comparable in both groups (CTO 8.8% vs 7.0% in non-CTO;p = 0.557). At two-year follow-up, a higher target lesion failure (TLF) was observed in CTO group (25.5% vs 15.1%, log rank p = 0.041), driven by higher cardiac mortality while the clinically driven target lesion revascularisation (TLR) was comparable between the study groups. Elective RA for CTO had a shorter procedural time and lower rate of dissection (7.5% vs 25%; p = 0.030) compared to bail-out RA with similar long-term outcomes. Conclusion Compared to non-CTO, RA for CTO can be performed with a high procedural success rate and comparable in-hospital outcomes. Apart from higher cardiac mortality in the CTO group, the long-term outcomes are comparable in both groups. Elective RA is a feasible and beneficial approach to be used in CTO intervention.
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Matsuura H, Mukai Y, Honda Y, Nishino S, Kang H, Kadooka K, Ogata K, Kimura T, Koiwaya H, Nishihira K, Kuriyama N, Shibata Y. Intra- and Postprocedural Management of Coronary Artery Perforation During Percutaneous Coronary Intervention. Circ Rep 2022; 4:517-525. [DOI: 10.1253/circrep.cr-22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hirohide Matsuura
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Yasushi Mukai
- Department of Cardiology, Japanese Red Cross Fukuoka Hospital
| | - Yasuhiro Honda
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Honsa Kang
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kosuke Kadooka
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Toshiyuki Kimura
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Hiroshi Koiwaya
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
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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:e002076. [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] [MESH Headings] [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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Ford TJ, Adamson C, Morrow AJ, Rocchiccioli P, Collison D, McCartney PJ, Shaukat A, Lindsay M, Good R, Watkins S, Eteiba H, Robertson K, Berry C, Oldroyd KG, McEntegart M. Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study. J Am Heart Assoc 2022; 11:e024492. [PMID: 36129052 DOI: 10.1161/jaha.121.024492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (r=0.73; P<0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), P<0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; P<0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; P=0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Clinicaltrials.gov. Identifier: NCT03862352.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
- Faculty of Medicine University of Newcastle Callaghan NSW Australia
| | - Carly Adamson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Andrew J Morrow
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Damien Collison
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Peter J McCartney
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Richard Good
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
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Saito S, Yamazaki S, Takahashi A, Namiki A, Kawasaki T, Otsuji S, Nakamura S, Shibata Y. Intravascular Lithotripsy for Vessel Preparation in Calcified Coronary Arteries Prior to Stent Placement - Japanese Disrupt CAD IV Study 1-Year Results. Circ Rep 2022; 4:399-404. [PMID: 36120480 PMCID: PMC9437473 DOI: 10.1253/circrep.cr-22-0068] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Intravascular lithotripsy (IVL) delivers acoustic pressure waves to modify calcium, enhance vessel compliance, and optimize stent deployment. The Disrupt CAD IV study enrolled patients with severe coronary artery calcification and demonstrated low 30-day major adverse cardiovascular events (MACE) and high procedural success following IVL with no final serious angiographic complications. To date, long-term outcomes have not been reported. This analysis evaluates 1-year outcomes of Disrupt CAD IV. Methods and Results: Disrupt CAD IV was a prospective single-arm multicenter study of IVL performed in a Japanese population with severe coronary artery calcification. Main outcomes included MACE (a composite of cardiac death, myocardial infarction [MI], or target vessel revascularization [TVR]), and target lesion failure (TLF; a composite of cardiac death, target vessel MI, and target lesion revascularization [TLR]) at 1 year. Compliance with patient follow-up at 1 year was 100%. MACE occurred in 9.4% of patients (cardiac death 0.0%, MI 6.3%, TVR 4.7%) and TLF occurred in 6.3% of patients, with both rates driven by non-Q wave MIs (6.3%). The TLR rate at 1 year was 1.6% and no stent thrombosis events were reported. Conclusions: Treatment of severely calcified coronary lesions with IVL was associated with low rates of 1-year MACE and TLR, suggesting durable safety and effectiveness of IVL-facilitated coronary stent implantation in severely calcified lesions in a Japanese population.
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Impact of Subintimal Plaque Modification on Reattempted Chronic Total Occlusions Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1427-1437. [PMID: 35863791 DOI: 10.1016/j.jcin.2022.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/29/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Predictors of success in reattempted chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures remain obscure, mainly owing to the lack of consecutive angiograms and procedural records of initial attempts in the same cohort. OBJECTIVES This study sought to investigate the factors predicting the success of reattempted CTO PCI procedures. METHODS A total of 208 consecutive patients who underwent a failed CTO PCI attempt and received reattempted procedure at the same cardiac center were retrospectively analyzed. Predictors of the success of reattempted procedures were evaluated. RESULTS The overall technical success rate of reattempted CTO PCI procedures was 71.2%. Subintimal plaque modification (SPM) was implemented in 35 (16.8%) procedures in initial attempts. The reattempted technical success rate was 93.3% in cases in which SPM with guidewire (GW) crossing was achieved in the initial attempt; however, the success rate was 55.0% for procedures involving SPM without GW crossing. SPM with GW crossing (OR: 11.21; 95% CI: 1.31-96.16; P = 0.028), referral to high-volume operators (OR: 2.38; 95% CI: 1.14-4.98; P = 0.021), and a bidirectional approach (OR: 2.31; 95% CI: 1.12-4.79; P = 0.024) were positive independent predictors of technical success in the subsequent reattempt. The time interval for reattempt (per 90-day increment) was negatively correlated with the technical success of the reattempted procedures (OR: 0.85; 95% CI: 0.73-0.98; P = 0.030). CONCLUSIONS This study identified independent predictors of success in reattempted CTO PCI procedures. SPM with GW crossing achieved in the initial attempt is associated with a higher success rate in the subsequent reattempt.
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Fujihara M, Kurata N, Yazu Y, Mori S, Tomoi Y, Horie K, Nakama T, Tsujimura T, Nakata A, Iida O, Sonoda S, Torii S, Ishihara T, Azuma N, Urasawa K, Ohki T, Komori K, Kichikawa K, Yokoi H, Nakamura M. Clinical expert consensus document on standards for lower extremity artery disease of imaging modality from the Japan Endovascular Treatment Conference. Cardiovasc Interv Ther 2022; 37:597-612. [DOI: 10.1007/s12928-022-00875-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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PK papyrus: The new standard for sealing large vessel coronary perforations. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:102-103. [PMID: 35864000 DOI: 10.1016/j.carrev.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022]
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Pavani M, Cerrato E, Franzè A, Colombo F, Ryan N, Durante A, Bellini B, Calcagno S, Montorfano M, Gonzalo N, Azzalini L, Escaned J, Varbella F. Grade 3 coronary artery perforations in chronic total occlusion-percutaneous coronary intervention: Mechanisms, locations, and outcomes from the G3CAP Registry. Catheter Cardiovasc Interv 2022; 100:190-198. [PMID: 35686523 DOI: 10.1002/ccd.30293] [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] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/09/2022]
Abstract
AIM The impact of Grade III coronary perforations (G3-CP) in the setting of CTO-PCI is not well assessed. METHODS AND RESULTS We reviewed 7773 CTO-PCI and 98,819 non CTO-PCI performed in 10 European centers: G3 perforation occurred in 87 patients (1.1%) during CTO PCI and 224 patients (0.22%) during non CTO-PCI (p < 0.001). G3-CP involved the CTO segment in 68% of patients and the retrograde channels in 14% of cases. In the CTO PCI group, wire induced G3-CP (50.5% vs. 32.5%, p = 0.02) occurred predominantly when dedicated CTO tapered and highly penetrative wires were used. Intra-procedural and in-hospital death rates were 4.6% vs. 5.8% and 3.6% vs. 7.5% respectively for CTO PCI and non-CTO PCI groups (p = NS). At a median follow up of 24 months, the overall mortality and MAE were respectively 7.8% and MAE 19% without difference among groups. CONCLUSIONS We showed similar in-hospital and long-term outcomes when G3 perforations occurred during CTO PCI and non CTO-PCI.
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Affiliation(s)
- Marco Pavani
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Enrico Cerrato
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Alfonso Franzè
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Nicola Ryan
- Department of Cardiology, Aberdeeen Royal Infirmary, Aberdeen, Scotland
| | | | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Calcagno
- Cardiology Department, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Nieves Gonzalo
- Cardiologia Interventionista, Hospital Clinico San Carlos, Madrid, Spain
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Javier Escaned
- Cardiologia Interventionista, Hospital Clinico San Carlos, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
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Ribeiro MH, Campos CM, Padilla L, da Silva ACB, de Paula JET, Alcantara M, Santiago R, Hanna F, da Silva FR, Belli KC, Azzalini L, de Oliveira PP, Araujo GN, Sucato V, Mashayekhi K, Galassi AR, Abizaid A, Quadros A. Risk Burden of Coronary Perforation in Chronic Total Occlusion Recanalization: Latin American CTO Registry Analysis. J Am Heart Assoc 2022; 11:e024815. [PMID: 35656976 PMCID: PMC9238716 DOI: 10.1161/jaha.121.024815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Coronary perforation is a life‐threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited. Methods and Results Data from LATAM (Latin American)‐CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30‐day, 1‐year major adverse cardiac events of coronary perforation using time‐to‐event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention‐Chronic total occlusions scores were 2.0 (1.0–3.0) and 1.0 (0.0–2.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1‐year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%; P<0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6 months (P=0.04) and 1 year (P<0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time (P<0.01), Multicenter CTO Registry in Japan score ≥2 (P=0.05), antegrade knuckle wire (P=0.04), and right coronary artery CTO PCI (P=0.05). Conclusions Coronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6 months and 1 year follow‐up.
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Affiliation(s)
| | - Carlos M Campos
- Heart Institute (InCor)Universidade de São Paulo (USP) São Paulo Brazil.,Instituto Prevent Senior, Sao Paulo São Paulo Brazil
| | - Lucio Padilla
- Interventional Cardiology Division Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | - João Eduardo T de Paula
- Interventional Cardiology Division Instituto Cardiovascular de Linhares UNICOR Linhares Espírito Santo Brazil
| | - Marco Alcantara
- Centro Médico Nacional 20 de Noviembre ISSSTE System Mexico City México
| | | | | | - Franciele R da Silva
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Karlyse C Belli
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Lorenzo Azzalini
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Pedro P de Oliveira
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Gustavo N Araujo
- Imperial Hospital de Caridade Florianópolis Santa Catarina Brazil
| | | | - Kambis Mashayekhi
- Division of Cardiology and Angiology II University Heartcenter Freiburg - Bad Krozingen Germany
| | | | - Alexandre Abizaid
- Heart Institute (InCor)Universidade de São Paulo (USP) São Paulo Brazil
| | - Alexandre Quadros
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
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Miura K, Tanaka H, Kishi K, Muramatsu T, Okada H, Oikawa Y, Kawasaki T, Yoshikawa R, Okamura A, Tsuchikane E. Impact of Timing and Treatment Strategy on Coronary Perforation During Percutaneous Coronary Intervention for Chronic Total Occlusion. Am J Cardiol 2022; 172:26-34. [PMID: 35430083 DOI: 10.1016/j.amjcard.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
Coronary perforations during chronic total occlusion percutaneous coronary intervention (CTO-PCI) are potential complications and reportedly associated with adverse events. This study aimed to describe the clinical characteristics and timing of perforations during CTO-PCI. Data from the Japanese CTO-PCI expert registry included 8,760 patients who underwent CTO-PCI between January 2014 and January 2019. The major adverse cardiac and cerebrovascular events were defined as death, tamponade, myocardial infarction, stent thrombosis, stroke, and revascularization. The guidewire manipulation time was defined as the time required to cross the CTO without perforation. Among these patients, 333 (3.8%) developed perforation during the CTO crossing attempt. Of the 333 patients, 29 developed cardiac tamponades (8.7%). Perforations more frequently occurred in a retrograde wiring than in an anterograde wiring (6.6% vs 1.7%, p <0.0001). A longer guidewire manipulation time was associated with the occurrence of perforation (median 101 minutes [interquartile range 59 to 150 minutes] in the perforation group vs 54.9 minutes [interquartile range 21.1 to 112.7 minutes] in the nonperforation group, p <0.0001). Risk factors for perforation were age, history of coronary bypass graft, right coronary artery lesion, de novo lesion, use of a stiff guidewire, and guidewire manipulation time of >60 minutes during anterograde wiring and age, non-left anterior descending artery lesion, use of a polymer-jacketed guidewire, and use of epicardial channel during retrograde wiring. In conclusion, risk factors for perforation were different between anterograde and retrograde wirings. A prolonged guidewire manipulation time was associated with the occurrence of perforation, especially during anterograde wiring.
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Navab R, N SR. Perforation of Right Coronary Artery During Coronary Angioplasty: A Rare Complication. Cureus 2022; 14:e25278. [PMID: 35755495 PMCID: PMC9219357 DOI: 10.7759/cureus.25278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Coronary angioplasty procedure, also known as percutaneous transluminal coronary angioplasty (PTCA), is performed to restore blood flow across significantly blocked coronary vessels. Perforation of coronary vessels may occur rarely during the procedure or within 24 hours post-procedure and is considered a serious complication. We wish to share our experience of a case of perforation in the proximal and mid-portion of the right coronary artery (RCA) during coronary angioplasty. To seal the perforation, the balloon was inflated and vitals were monitored. Check coronary angiography showed persisting extravasation but with no collection on serial echocardiograms. It was confirmed that the perforation was not in the pericardial space but inside the cardiac chamber. The patient was shifted to the cardiac care unit, for further monitoring of vitals and echocardiogram studies for the next 72 hours to ensure recovery. Wire-induced coronary perforations into the cardiac chamber are most of the time benign and are conservatively managed.
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van Hattem VAE, Otterspoor LC, Lipsic E, Vlaar PJJJ. Right ventricular hematoma: A rare but potentially fatal complication of percutaneous coronary artery intervention. Catheter Cardiovasc Interv 2022; 100:100-104. [PMID: 35555948 DOI: 10.1002/ccd.30226] [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] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022]
Abstract
Right ventricular hematoma secondary to coronary artery perforation during the percutaneous coronary intervention (PCI) is a rare complication. Nevertheless, with the growth of complex PCIs, including chronic total occlusion procedures, this complication may increase in frequency. We describe three cases of subepicardial right ventricular hematoma after complex right coronary artery PCI with different outcomes. Two cases were successfully managed with medication only. One case was managed with medication and pericardial drainage, unfortunately with a fatal outcome. All cases emphasize the need for awareness concerning this complication, which warrants prompt diagnosis and adequate therapy.
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Affiliation(s)
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Pieter-Jan J J Vlaar
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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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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