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Deshpande S, Sawatari H, Rangan K, Buchade A, Ahmed R, Ramphul K, Ahmed M, Khanji MY, Somers VK, Shahid F, Chahal AA, Padmanabhan D. Pericardial tamponade in coronary interventions: Morbidity and mortality. Catheter Cardiovasc Interv 2024; 104:707-713. [PMID: 39248175 DOI: 10.1002/ccd.31213] [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: 05/17/2024] [Revised: 08/03/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Cardiac tamponade or pericardial tamponade (PT) can be a complication following invasive cardiac procedures. METHODS Patients who underwent various procedures in the cardiac catheterization lab (viz. coronary interventions) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (International classification of diseases [ICD]-9-Clinical modification [CM] and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, PT-related events, and in-hospital death were also abstracted from the NIS database. RESULTS The frequency of PT-related events in the patients undergoing CI from 2010 to 2017 ranged from 3.3% to 8.4%. Combined in-hospital mortality/morbidity of PT-related events were higher with increasing age (odds ratio [OR] [95% CI]: chronic total occlusion (CTO) = 1.19 [1.10-1.29]; acute coronary syndrome (ACS) = 1.21 [1.11-1.33], both p < 0.0001) and female sex (OR [95%CI]: CTO = 1.70 [1.45-2.00]; ACS = 1.72 [1.44-2.06], both p < 0.0001). In-hospital mortality related to PT-related events was found to be 8.5% for coronary procedures. In-hospital mortality was highest amongst the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for ACS (ACS vs. non-CTO PTCA vs. CTO PTCA: 15.7% vs. 10.4% and 14.4%, p < 0.0001 and ACS vs. non-CTO PTCA vs. CTO PTCA: 12.1% vs. 8.1% and 5.6%, p = 0.0001, respectively). CONCLUSIONS In the real-world setting, PT-related events in CI were found to be 3.3%-8.4%, with in-hospital mortality of 8.5%. The patients undergoing PTCA for ACS were found to have highest mortality. Older patients undergoing CTO PTCA independently predicted higher mortality.
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Affiliation(s)
- Saurabh Deshpande
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Hiroyuki Sawatari
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kapil Rangan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Anusha Buchade
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
| | | | | | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania, USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, West Smithfield, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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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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5
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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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Loh SX, Brilakis E, Gasparini G, Agostoni P, Garbo R, Mashayekhi K, Alaswad K, Goktiken O, Avran A, Knaapen P, Nap A, Elguindi A, Tammam K, Yamane M, Stone GW, Egred M. Coils embolization use for coronary procedures: Basics, indications, and techniques. Catheter Cardiovasc Interv 2023; 102:900-911. [PMID: 37668102 DOI: 10.1002/ccd.30821] [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: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
The use of coils is fundamental in interventional cardiology and can be lifesaving in selected settings. Coils are classified by their materials into bare metal, fiber coated, and hydrogel coated, or by the deliverability method into, pushable or detachable coils. Coils are delivered through microcatheters and the choice of coil size is important to ensure compatibility with the inner diameter of the delivery catheter, firstly to be able to deliver and secondly to prevent the coil from being stuck and damaged. Clinically, coils are used in either acute or in elective setting. The most important acute indication is typically the sealing coronary perforation. In the elective settings, coils can be used for the treatment of certain congenital cardiac abnormalities, aneurysms, fistulas or in the treatment of arterial side branch steal syndrome after CABG. Coils must always be delivered under fluoroscopy guidance. There are some associated complications with coils that can be acute or chronic, that nictitates regular followed-up. There is a need for education, training and regular workshops with hands-on to build the experience to use coils in situations that are infrequently encountered.
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Affiliation(s)
- Shu Xian Loh
- Cardiothoracic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Emmanuelle Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Roberto Garbo
- Interventional Cardiology Department, Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Kambis Mashayekhi
- Internal Medicine and Cardiology, MediClin Heartcenter, Herzzentrum Lahr, Hohbergweg, Germany
| | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | | | | | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alex Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ahmed Elguindi
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- School of Medicine, University of Sunderland, Sunderland, UK
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7
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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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8
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Deshpande S, Swatari H, Ahmed R, Collins G, Khanji MY, Somers VK, Chahal AA, Padmanabhan D. Predictors of morbidity and in-hospital mortality following procedure-related cardiac tamponade. J Arrhythm 2023; 39:790-798. [PMID: 37799802 PMCID: PMC10549810 DOI: 10.1002/joa3.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
Background Cardiac tamponade (CT) can be a complication following invasive cardiac procedures. We assessed CT following common cardiac electrophysiology (EP) procedures to facilitate risk prediction of associated morbidity and in-hospital mortality. Methods Patients who underwent various EP procedures in the cardiac catheterization lab (ablations and device implantations) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (ICD-9-CM and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, CT-related events, and in-hospital death were also abstracted from the NIS database. Results The frequency of CT-related events in patients with EP intervention from 2010 to 2017 ranged from 3.4% to 7.0%. In-hospital mortality related to CT-related events was found to be 2.2%. Increasing age was the only predictor of higher mortality in atrial fibrillation (AF) ablation and cardiac resynchronization therapy (CRT) groups (OR [95% CI]: AF ablation = 11.15 [1.70-73.34], p = .01; CRT = 1.41 [1.05-1.90], p = .02). Conclusions In the real-world setting, CT-related events in EP procedures were found to be 3.4%-7.0% with in-hospital mortality of 2.2%. Older patients undergoing AF ablation were found to have higher mortality.
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Affiliation(s)
| | - Hiroyuki Swatari
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Raheel Ahmed
- Department of CardiologyNorthumbria Healthcare NHS Foundation TrustNewcastleUK
| | | | - Mohammed Y. Khanji
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUK
| | - Virend K. Somers
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | - Anwar A. Chahal
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUK
- Cardiac Electrophysiology Section, Division of Cardiovascular DiseasesUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Deepak Padmanabhan
- Jayadeva Institute of Cardiac Sciences and ResearchBangaloreIndia
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
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9
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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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10
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Demir M, Gök M, Gürdoğan M, Kula O, Ustabaşıoğlu FE, Yalta K. A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction. Arq Bras Cardiol 2023; 120:e20220901. [PMID: 37672407 PMCID: PMC10519249 DOI: 10.36660/abc.20220901] [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: 12/15/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023] Open
Abstract
Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs).1 On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context.2 Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).
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Affiliation(s)
- Melik Demir
- Trakya UniversityFaculty of MedicineDepartment of CardiologyEdirneTurquiaDepartment of Cardiology Trakya University Faculty of Medicine, Edirne – Turquia
| | - Murat Gök
- Trakya UniversityFaculty of MedicineDepartment of CardiologyEdirneTurquiaDepartment of Cardiology Trakya University Faculty of Medicine, Edirne – Turquia
| | - Muhammet Gürdoğan
- Trakya UniversityFaculty of MedicineDepartment of CardiologyEdirneTurquiaDepartment of Cardiology Trakya University Faculty of Medicine, Edirne – Turquia
| | - Osman Kula
- Trakya UniversityFaculty of MedicineDepartment of RadiologyEdirneTurquiaDepartment of Radiology Trakya University Faculty of Medicine, Edirne – Turquia
| | - Fethi Emre Ustabaşıoğlu
- Trakya UniversityFaculty of MedicineDepartment of RadiologyEdirneTurquiaDepartment of Radiology Trakya University Faculty of Medicine, Edirne – Turquia
| | - Kenan Yalta
- Trakya UniversityFaculty of MedicineDepartment of CardiologyEdirneTurquiaDepartment of Cardiology Trakya University Faculty of Medicine, Edirne – Turquia
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11
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Shah T, Abu-Much A, Batchelor WB, Grines CL, Baron SJ, Zhou Z, Li Y, Maini AS, Redfors B, Hussain Y, Wollmuth JR, Basir MB, O'Neill WW, Lansky AJ. Sex Differences in pLVAD-Assisted High-Risk Percutaneous Coronary Intervention: Insights From the PROTECT III Study. JACC Cardiovasc Interv 2023:S1936-8798(23)00806-3. [PMID: 37409991 DOI: 10.1016/j.jcin.2023.04.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Prior studies have found that female patients have worse outcomes following high-risk percutaneous coronary intervention (HRPCI). OBJECTIVES The authors sought to evaluate sex-based differences in patient and procedural characteristics, clinical outcomes, and safety of Impella-supported HRPCI in the PROTECT III study. METHODS We evaluated sex-based differences in the PROTECT III study; a prospective, multicenter, observational study of patients undergoing Impella-supported HRPCI. The primary outcome was 90-day major adverse cardiac and cerebrovascular events (MACCE)-the composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization. RESULTS From March 2017 to March 2020, 1,237 patients (27% female) were enrolled. Female patients were older, more often Black, more often anemic, and had more prior strokes and worse renal function, but higher ejection fractions compared to male patients. Preprocedural SYNTAX score was similar between sexes (28.0 ± 12.3). Female patients were more likely to present with acute myocardial infarction (40.7% vs 33.2%; P = 0.02) and more often had femoral access used for PCI and nonfemoral access used for Impella device implantation. Female patients had higher rates of immediate PCI-related coronary complications (4.2% vs 2.1%; P = 0.004) and a greater drop in SYNTAX score post-procedure (-22.6 vs -21.0; P = 0.04). There were no sex differences in 90-day MACCE, vascular complications requiring surgery, major bleeding, or acute limb ischemia. After adjustment using propensity matching and multivariable regression, immediate PCI-related complications was the only safety or clinical outcome that was significantly different by sex. CONCLUSIONS In this study, rates of 90-day MACCE compared favorably to prior cohorts of HRPCI patients and there was no significant sex differences. (The PROTECT III Study is a substudy of The Global cVAD Study [cVAD]; NCT04136392).
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Affiliation(s)
- Tayyab Shah
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Suzanne J Baron
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Yanru Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Aneel S Maini
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yasin Hussain
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - M Babar Basir
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Alexandra J Lansky
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA; Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom.
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12
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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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13
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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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14
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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15
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Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Jaffer FA, Khatri JJ, Choi JW, Jaber WA, Rinfret S, Nicholson W, Patel MP, Mahmud E, Toma C, Davies RE, Kerrigan JL, Haddad EV, Gorgulu S, Abi-Rafeh N, ElGuindy AM, Goktekin O, Allana S, Burke MN, Mastrodemos OC, Rangan BV, Brilakis E. Development and validation of a scoring system for predicting clinical coronary artery perforation during percutaneous coronary intervention of chronic total occlusions: the PROGRESS-CTO perforation score. EUROINTERVENTION 2023; 18:1022-1030. [PMID: 36281650 PMCID: PMC9853034 DOI: 10.4244/eij-d-22-00593] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and often leads to serious adverse clinical events. AIMS We sought to develop a risk score to predict clinical coronary artery perforation in patients undergoing CTO PCI. METHODS We analysed clinical and angiographic parameters from 9,618 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO). Logistic regression prediction modelling was used to identify variables independently associated with clinical perforation, and the model was internally validated with bootstrapping. Clinical coronary artery perforation was defined as any perforation requiring treatment. RESULTS The incidence of clinical coronary perforation was 3.8% (n=367). Five factors were independently associated with perforation and were included in the score: patient age ≥65 years +1 point (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.37-2.33), moderate/severe calcification +1 point (OR 1.85, 95% CI: 1.41-2.42), blunt/no stump +1 point (OR 1.45, 95% CI: 1.10-1.92), use of antegrade dissection and re-entry +1 point (OR 2.43, 95% CI: 1.61-3.69), and use of the retrograde approach +2 points (OR 4.02, 95% CI: 2.95-5.46). The resulting score showed acceptable performance on receiver operating characteristic (ROC) curve (area under the curve [AUC]: 0.741, 95% CI: 0.712-0.773). The Hosmer-Lemeshow test indicated a good fit (p=0.991), and internal validation with bootstrapping demonstrated good agreement with the model with observed AUC: 0.736 (95% bias-corrected CI: 0.706-0.767). CONCLUSIONS The PROGRESS-CTO perforation score may be a useful tool for predicting clinical coronary perforation during CTO PCI.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, TX, USA
| | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Elias V Haddad
- Ascension Saint Thomas Heart Hospital, Nashville, TN, USA
| | | | | | | | | | - Salman Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
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16
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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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17
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Tehrani DM, Seto AH. Management of Coronary Complications. Interv Cardiol Clin 2022; 11:445-453. [PMID: 36243489 DOI: 10.1016/j.iccl.2022.06.002] [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] [Indexed: 06/16/2023]
Abstract
Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most serious coronary complications including acute vessel closure from dissection, no-reflow, thrombosis, and air embolism as well as mechanical complications including perforation, stent dislodgment, and atherectomy burr entrapment.
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Affiliation(s)
- David M Tehrani
- University of California Los Angeles, 650 Charles East Young Drive South, A20237 CHS, Los Angeles, CA 90095, USA.
| | - Arnold H Seto
- Long Beach Veterans Administration Medical Center, 5901 East 7th Street 111C, Long Beach, CA 90822, USA
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18
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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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19
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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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20
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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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21
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Umar H, Sharma H, Osheiba M, Roy A, Ludman PF, Townend JN, Nadir MA, Doshi SN, George S, Zaphiriou A, Khan SQ. Changing trends in the incidence, management and outcomes of coronary artery perforation over an 11-year period: single-centre experience. Open Heart 2022; 9:openhrt-2021-001916. [PMID: 35483748 PMCID: PMC9052042 DOI: 10.1136/openhrt-2021-001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Coronary artery perforation (CP) is a rare but life-threatening complication of percutaneous coronary intervention (PCI). This study aimed to assess the incidence, management and outcomes of CP over time. Methods A single-centre retrospective cohort study of all PCIs performed between January 2010 and December 2020. Patients with CP were divided into two cohorts (A+B), representing the two halves of the 11-year study. Results The incidence of CP was 68 of 9701 (0.7%), with an increasing trend over the two 5.5-year periods studied (24 of 4661 (0.5%) vs 44 of 5040 (0.9%); p=0.035). Factors associated with CP included chronic total occlusions (CTOs) (16 of 68 (24%) vs 993 of 9633 (10%); p<0.001), type C lesions (44 of 68 (65%) vs 4280 of 9633 (44%); p<0.001), use of intravascular ultrasound (IVUS) (12 of 68 (18%) vs 541 of 9633 (6%); p<0.001), cutting balloon angioplasty (3 of 68 (4%) vs 98 of 9633 (1%); p<0.001) and hydrophilic wires (24 of 68 (35%) vs 1454 of 9633 (15%); p<0.001). Cohorts A and B were well matched with respect to age (69±11 vs 70±12 years; p=0.843), sex (males: 13 of 24 (54%) vs 31 of 44 (70%); p=0.179) and renal function (chronic kidney disease: 1 of 24 (4%) vs 4 of 44 (9%); p=0.457). In cohort A, CP was most frequently caused by post-dilatation with non-compliant balloons (10 of 24 (42%); p=0.009); whereas in cohort B, common causes included guidewire exits (23 of 44 (52%)), followed by stent implantation (10 of 44 (23%)). The most common treatment modality in cohorts A and B was balloon inflation, which accounted for 16 of 24 (67%) and 13 of 44 (30%), respectively. The use of covered stents (16%) and coronary coils (18%) during cohort B study period did not impact all-cause mortality, which occurred in 2 of 24 (8%) and 7 of 44 (16%) (p=0.378) in cohorts A and B, respectively. Conclusion The incidence of CP is increasing as more complex PCI is performed. Factors associated with perforation include CTO or type C lesions and use of IVUS, cutting balloon angioplasty or hydrophilic wires.
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Affiliation(s)
- Hamza Umar
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Harish Sharma
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK .,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Mohammed Osheiba
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ashwin Roy
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Peter F Ludman
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - M Adnan Nadir
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sudhakar George
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Alex Zaphiriou
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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22
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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23
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Kassier A, Fischell TA. Managing coronary artery perforation after percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2022; 20:215-222. [PMID: 35341445 DOI: 10.1080/14779072.2022.2059465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Coronary artery perforation is a serious complication during percutaneous coronary intervention that results in significant increase in morbidity and mortality. In this article, we provide a state-of-the-art overview of the contemporary management of coronary perforation and the possible scenarios that operators may run into during percutaneous coronary interventions. AREA COVERED Coronary perforation during percutaneous coronary intervention. Literature search was performed using PubMed and Google Scholar to identify the most recently published articles covering this topic. EXPERT OPINION As part of this review, we also provide an expert commentary discussing the nuances in the recognition and management of coronary artery perforation, in addition to future directions, and improvements in technology that could make the management of coronary perforation safer and more effective.
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Affiliation(s)
- Adnan Kassier
- Department of interventional cardiology, Ascension Borgess Hospital, Kalamazoo, Michigan, United States
| | - Tim A Fischell
- Department of interventional cardiology, Ascension Borgess Hospital, Kalamazoo, Michigan, United States
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24
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Al-Omary MS, Collins NJ, Sung JG, Bhagwandeen R, Ho KH, Yam PW, Wu EB, Lam H. Absorbable Suture Embolization in Distal Coronary Perforation. JACC Case Rep 2022; 4:133-136. [PMID: 35199003 PMCID: PMC8853958 DOI: 10.1016/j.jaccas.2021.11.017] [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] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Coronary artery perforation is a rare but serious complication during percutaneous coronary intervention. Distal or small vessel perforation is usually treated by coil, fat, or microsphere embolization. We describe 5 cases of distal coronary perforation that were managed successfully by a novel technique that uses absorbable sutures. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Mohammed S. Al-Omary
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
- John Hunter Hospital, Newcastle, Australia
- Tuen Mun Hospital, Hong Kong
- Address for correspondence: Dr. Mohammed S. Al-Omary, Prince of Wales and Tuen Mun Hospitals, Hong Kong SAR.
| | | | | | | | | | | | - Eugene B. Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
| | - Ho Lam
- Tuen Mun Hospital, Hong Kong
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25
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Shamkhani W, Kinnaird T, Ludman P, Rashid M, Mamas MA. Sex differences in high‐risk but indicated coronary interventions (CHiP): National report from British Cardiovascular Intervention Society Registry. Catheter Cardiovasc Interv 2022; 99:447-456. [DOI: 10.1002/ccd.30081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Warkaa Shamkhani
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
| | - Tim Kinnaird
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology University Hospital of Wales Cardiff Cardiff UK
| | - Peter Ludman
- Department of Cardiology Queen Elizabeth Hospital Birmingham West Midlands UK
| | - Muhammad Rashid
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
| | - Mamas A. Mamas
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
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26
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Guddeti RR, Kostantinis ST, Karacsonyi J, Brilakis ES. Distal coronary perforation sealing with combined coil and fat embolization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:222-224. [PMID: 34903484 DOI: 10.1016/j.carrev.2021.12.001] [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: 08/09/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022]
Abstract
Distal coronary perforation is a rare complication of percutaneous coronary intervention. While temporary balloon occlusion of the proximal coronary artery is the first step in perforation management, more definitive treatment options include covered stent implantation for large vessel perforations or fat/coil embolization for distal vessel perforations. We report a case of an 81-year old man who presented with inferior/posterior ST-segment elevation acute myocardial infarction. Coronary angiography showed a 90% distal left circumflex artery (LCx) stenosis. Percutaneous coronary intervention of the culprit vessel was challenging due to balloon uncrossable lesions in LCx and was complicated by distal coronary perforation due to excessive wire movement. Two Axium coils were delivered using a Finecross microcatheter but failed to seal the perforation. We performed fat embolization (proximal to the coils) that successfully sealed the perforation. In selected cases where coil embolization alone fails to seal a distal coronary perforation, combined coil and fat embolization might help achieve hemostasis.
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27
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Gawalkar AA, Singh N, Gupta A, Barwad P. Looped wire advancement—not always safe! Fat—not so useless! a case series. Eur Heart J Case Rep 2021; 5:ytab400. [PMID: 34816082 PMCID: PMC8603226 DOI: 10.1093/ehjcr/ytab400] [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] [Received: 05/14/2021] [Revised: 06/03/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Abstract
Background Coronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it. Case summary We hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP. Discussion Distal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.
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Affiliation(s)
- Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research , Sector 12 , Chandigarh 160 012, India
| | - Navreet Singh
- Department of Cardiology, Air Force Central Medical Establishment, Subroto Park, New Delhi, 110010 , India
| | - Ankush Gupta
- Department of Cardiology, Military Hospital, Bani Park, Jaipur, Rajasthan, 302016 , India
| | - Parag Barwad
- Department of Cardiology, Post Graduate Institute of Medical Education & Research , Sector 12 , Chandigarh 160 012, India
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29
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Voll F, Kuna C, Kufner S, Cassese S. [Technical armamentarium for chronic total occlusion of coronary vessels]. Herz 2021; 46:406-418. [PMID: 34398249 DOI: 10.1007/s00059-021-05053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Percutaneous revascularization of chronic total occlusion (CTO) of coronary vessels represents a major challenge for contemporary interventional cardiologists. In the last decade there has been an unprecedented effort towards the standardization of revascularization procedures for CTO of coronary vessels. This endeavour has been possible by virtue of the growing interest of various cardiological societies for this patient group. Along with supportive endovascular technologies and percutaneous devices specifically dedicated to this interventional target, the increasing experience of interventionalists enabled continuously growing success for revascularization of CTO of coronary vessels. This review article highlights the currently available tools as well as technologies, techniques and strategies for the percutaneous recanalization of CTO of coronary vessels.
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Affiliation(s)
- F Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - C Kuna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland.
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30
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Abdalwahab A, McQuillan C, Farag M, Egred M. Novel economic treatment for coronary wire perforation: A case report. World J Cardiol 2021; 13:177-182. [PMID: 34194636 PMCID: PMC8223700 DOI: 10.4330/wjc.v13.i6.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with embolization of coils, fat, thrombin, or collagen. We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation. we advocate this method as a simple method of managing distal vessel perforation.
CASE SUMMARY A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex. At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation. A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.
CONCLUSION The use of a balloon remnant for embolization in coronary perforation presents a simple, efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome. Prevention remains the most important part with meticulous attention to the distal wire position, particularly with hydrophilic wires.
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Affiliation(s)
- Ahmed Abdalwahab
- Department of Cardiothoracic, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
- Freeman Hospital & Department of Cardiovascular Medicine, Tanta University, Tanta 31512, Egypt
| | - Conor McQuillan
- Freeman Hospital & Department of Cardiology, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, United Kingdom
| | - Mohamed Farag
- Department of Cardiothoracic, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
- Freeman Hospital &School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, United Kingdom
| | - Mohaned Egred
- Department of Cardiothoracic, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
- Freeman Hospital &Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE7 7DN, United Kingdom
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31
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Gupta H, Kaur N, Sharma Y, Lim ST. Modified double guiding catheter 'Ping Pong' technique to treat large coronary perforation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab173. [PMID: 34124571 PMCID: PMC8189299 DOI: 10.1093/ehjcr/ytab173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/15/2020] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
Background Despite improvement in available tools and techniques, procedural complications like coronary perforation can occur during percutaneous coronary intervention (PCI). Severe proximal coronary perforations are usually caused by balloon and vessel size mismatch but can also occur with appropriately sized balloons or stents if the coronary vessel has very eccentric calcification or if there is negative remodelling of the vessel. Case summary A 74-year-old man with a history of type II diabetes mellitus, hypertension, and chronic coronary syndrome (previous PCI 10 years before) presented with unstable angina of 2 weeks of duration. Coronary angiography revealed a patent stent in left anterior descending artery, significant disease in left circumflex artery and diffuse calcified lesion in dominant right coronary artery (RCA). During angioplasty of RCA, the patient developed severe Ellis grade III perforation, which was successfully managed with modified double guiding catheter ‘Ping Pong’ technique. In this technique, the already engaged 7 French (F) Amplatz Left 1 guide catheter was used to deliver the bulky covered stent in highly tortuous and calcified RCA while a second 6F guide catheter (Judkin Right) introduced through contralateral femoral access was used for introducing the balloon, which initially sealed the perforation and subsequently acted as a distal anchor to provide strong support to deliver the covered stent. Conclusion In a case of severe coronary perforation, modified Ping Pong technique using a small-sized second guide catheter complimentary to the first guide catheter, can be used to deploy bulky covered stent.
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Affiliation(s)
- Himanshu Gupta
- Advance Cardiac Center, Sector 12, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, Indi a
| | - Navjyot Kaur
- Advance Cardiac Center, Sector 12, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, Indi a
| | - Yashpaul Sharma
- Advance Cardiac Center, Sector 12, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, Indi a
| | - Soo Teik Lim
- 5 Hospital Drive, Level 2 Pharmacy, National Heart Centre Singapore 169609
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Megaly M, Zordok M, Mentias A, Chugh Y, Buttar RS, Basir MB, Burke MN, Karmpaliotis D, Azzalini L, Alaswad K, Brilakis ES. Complications and failure modes of covered coronary stents: Insights from the MAUDE database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:157-160. [PMID: 34052127 DOI: 10.1016/j.carrev.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on the mechanisms of failure of covered coronary stents [Graftmaster, PK Papyrus] are limited. METHODS We queried the "Manufacturer and User Facility Device Experience" (MAUDE) database between August 2018 (when the PK Papyrus stent was FDA approved) and December 2020 for reports on covered coronary stents. RESULTS We identified 299 reports in the MAUDE database (after excluding duplicates, peripheral vascular reports, and incomplete records) (Graftmaster n = 225, PK Papyrus n = 74). The most common mechanism of failure of covered stents was failure to deliver the stent (46.2%), followed by stent dislodgement (22.4%) and failure to seal the perforation (19.7%). Failure to deliver the stent was more often reported with Graftmaster compared with PK Papyrus (59.1% vs. 6.8%, p < 0.001). Stent dislodgement was more often reported with PK Papyrus compared with Graftmaster (75.7% vs. 4.9%, p < 0.001) and was managed by device retrieval or by crushing the stent. CONCLUSIONS The most common failure mechanisms of covered stents are failure of delivery, stent dislodgement, and failure to seal the perforation. Failure of delivery was more common with Graftmaster, while stent dislodgement was more common with PK Papyrus. Further improvements in covered stent design are needed to optimize deliverability and minimize the risk of complications.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center/University of Arizona, Phoenix, AZ, United States of America
| | - Magdi Zordok
- Department of Medicine, Steward Carney Hospital, Boston, MA, United States of America
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Yashasvi Chugh
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Rupinder S Buttar
- Department of Medicine, Rochester Regional Health, Rochester, NY, United States of America
| | - Mir B Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Dimitrios Karmpaliotis
- Department of Cardiovascular Medicine, Columbia University, New York, NY, United States of America
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Khaldoon Alaswad
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
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Bouisset F, Ribichini F, Bataille V, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Zajdel W, Faurie B, Mezilis N, Palazuelos J, Spedicato L, Valdés M, Vaquerizo B, Ferenc M, Cayla G, Barbato E, Carrié D. Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry). Am J Cardiol 2021; 143:29-36. [PMID: 33359202 DOI: 10.1016/j.amjcard.2020.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.
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Cerrato E, Pavani M, Barbero U, Colombo F, Mangieri A, Ryan N, Quadri G, Tomassini F, Presutti DG, Calcagno S, Franzè A, Bellini B, D'Ascenzo F, Ielasi A, De Benedictis M, Azzalini L, Mancone M, Escaned J, Montorfano M, Latib A, Varbella F. Incidence, Management, Immediate and Long-Term Outcome of Guidewire and Device Related Grade III Coronary Perforations (from G3CAP - Cardiogroup VI Registry). Am J Cardiol 2021; 143:37-45. [PMID: 33387472 DOI: 10.1016/j.amjcard.2020.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
Ellis grade III coronary artery perforations (G3-CAP) remain a life-threatening complication of percutaneous coronary intervention (PCI), with high morbidity and mortality and lack of consensus regarding optimal treatment strategies. We reviewed all PCIs performed in 10 European centers from 1993 to 2019 recording all G3-CAP along with management strategies, in-hospital and long-term outcome according to Device-related perforations (DP) and Guidewire-related perforations (WP). Among 106,592 PCI (including 7,773 chronic total occlusions), G3-CAP occurred in 311 patients (0.29%). DP occurred in 194 cases (62.4%), more commonly in proximal segments (73.2%) and frequently secondary to balloon dilatation (66.0%). WP arose in 117 patients (37.6%) with chronic total occlusions guidewires involved in 61.3% of cases. Overall sealing success rate was 90.7% and usually required multiple maneuvers (80.4%). The most commonly adopted strategies to obtain hemostasis were prolonged balloon inflation (73.2%) with covered stent implantation (64.4%) in the DP group, and prolonged balloon inflation (53.8%) with coil embolization (41%) in the WP group. Procedural or in-hospital events arose in 38.2% of cases: mortality was higher after DP (7.2% vs 2.6%, p = 0.05) and acute stent thrombosis 3-fold higher (3.1% vs 0.9%, p = 0.19). At clinical follow-up, median 2 years, a major cardiovascular event occurred in one-third of cases (all-cause mortality 8.2% and 7.1% respectively, without differences between groups). In conclusion, although rare and despite improved rates of adequate perforation sealing G3-CAP cause significant adverse events. DP and WP result in different patterns of G3-CAP and management strategies should be based on this classification.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy; Montefiore Medical Center, New York, New York.
| | - Marco Pavani
- Cardiology Unit, Santissima Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Umberto Barbero
- Cardiology Unit, Santissima Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | | | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | - Francesco Tomassini
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | | | - Simone Calcagno
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, Rome, Italy
| | - Alfonso Franzè
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza di Torino, Turin, Italy; Montefiore Medical Center, New York, New York
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center and Virginia Commonwealth University, Richmond, Virginia
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, Rome, Italy
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
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Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary artery perforations within chronic total occlusions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 16:399-409. [PMID: 33598012 PMCID: PMC7863825 DOI: 10.5114/aic.2020.101764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Patients treated within chronic total occlusions (CTO) using percutaneous coronary intervention (PCI) are at increased risk of periprocedural complications. Aim To assess the frequency of periprocedural complications with particular emphasis on coronary artery perforations (CAPs) among patients treated with PCIs stratified according to CTOs and their predictors. Material and methods Based on a nationwide registry (ORPKI), we analysed 535,853 patients treated with PCI between 2014 and 2018. The study included 12,572 (2.34%) patients treated with CTO PCI. We compared CTO PCI to a non-CTO PCI group before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of periprocedural complications and CAPs which occurred within the catheterization laboratory. Results Frequencies of all periprocedural complications (2.75% vs. 1.93%, p < 0.001) and CAP (0.72% vs. 0.16%, p < 0.001) were significantly higher in the CTO PCI group. Multifactorial regression analysis performed in the all-comers group of patients treated with PCI showed that PCI within CTO was related to a higher CAP rate (odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.68–2.82, p < 0.001). After PSM, we extracted 5,652 patients treated within CTO and 5,652 patients with non-CTO PCI. CTO PCI was also related to a higher frequency of CAPs (OR = 1.89; 95% CI: 1.11–3.31, p = 0.01). Conclusions The frequency of periprocedural complications and CAPs remained stable during the assessed period of time. CTO PCI was confirmed to be among the predictors of increased CAP rate in the overall group of patients treated within CTO.
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Impact of chronic total occlusion and revascularization strategy in patients with infarct-related cardiogenic shock: A subanalysis of the culprit-shock trial. Am Heart J 2021; 232:185-193. [PMID: 33253678 DOI: 10.1016/j.ahj.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/18/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The impact of coronary artery chronic total occlusion (CTO) and its management with percutaneous coronary intervention (PCI) in the setting of myocardial infarction (MI) related cardiogenic shock (CS) remains unclear. METHODS This is a pre-specified analysis from the culprit-lesion-only PCI vs multivessel PCI in CS (CULPRIT-SHOCK) trial which randomized patients presenting with MI and multivessel disease complicated by CS to a culprit-lesion-only or immediate multivessel PCI strategy. CTO was defined by central core-laboratory evaluation. The independent associations between the presence of CTO and adverse outcomes at 30 days and 1 year were assessed using multivariate logistics models. RESULTS A noninfarct related CTO was present in 157 of 667 (23.5%) analyzed patients. Patients presenting with CTO had more frequent diabetes mellitus or prior PCI but less frequently presented with ST segment elevation MI as index event. The presence of CTO was associated with higher rate of death at 30 days (adjusted Odds ratio 1.63; 95% confidence interval [CI] 1.01-2.60). Rate of death at 1 year was also increased but did not reach statistical significance (adjusted Odds ratio 1.62; 95%CI 0.99-2.66). Compare to immediate multivessel PCI, a strategy of culprit-lesion-only PCI was associated with lower rates of death or renal replacement therapy at 30 days in patients with and without CTO (Odds ratio 0.79 95%CI 0.42-1.49 and Odds ratio 0.67 95%CI 0.48-0.96, respectively), without significant interaction (P = .68). CONCLUSIONS In patients with MI-related CS and multivessel disease, the presence of CTO is associated with adverse outcomes while a strategy of culprit-lesion-only PCI seems beneficial regardless of the presence of CTO.
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Hussain HI, Protty MB, Gallagher S, Al-Raisi S, Aldalati O, Farooq V, Sharp ASP, Anderson R, Kinnaird T. The impact of coronary perforation in percutaneous interventions involving the left main stem coronary artery in the United Kingdom 2007-2014: Insights from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv 2021; 97:E179-E185. [PMID: 32333715 DOI: 10.1002/ccd.28933] [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: 01/25/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly utilized for treatment of coronary disease involving the unprotected left main stem (ULMS). However, no studies to date have examined the outcomes of such interventions when complicated by coronary perforation (CP). METHODS Using the British Cardiovascular Intervention society (BCIS) database, data were analyzed on all ULMS-PCI procedures complicated by CP in England and Wales between 2007 and 2014. Multivariate logistic regressions were used to identify predictors of ULMS CP and to evaluate the association between this complication and outcomes. RESULTS During 10,373 ULMS-PCI procedures, CP occurred more frequently than in non-ULMS-PCI (0.9 vs. 0.4%, p < .001) with a stable annual incidence. Covariates associated with CP included number of stents used, female gender, use of rotational atherectomy and chronic total occlusion (CTO) intervention. Adjusted odds of adverse outcomes for ULMS-PCI complicated by CP were higher for peri-procedural complications including cardiogenic shock, tamponade, side-branch loss, DC cardioversion, in-hospital major bleeding, transfusion requirement, and peri-procedural myocardial infarction. There were also significantly increased odds for in-hospital major adverse cardiac events (MACCE, OR 8.961, 95% CI [4.902-16.383]) and 30-day mortality (OR 5.301, 95% CI [2.741-10.251]). CONCLUSIONS CP is an infrequent event during ULMS-PCI and is predicted by female gender, rotational atherectomy, CTO interventions or number of stents used. CP was associated with significantly higher odds of mortality and morbidity, but at rates similar to previously published all-comer PCI complicated by CP.
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Affiliation(s)
| | - Majd B Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,Division of Immunity and Infection, Systems Immunity University Research Institute, Cardiff University, Cardiff, UK
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Sara Al-Raisi
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Omar Aldalati
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Vasim Farooq
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, Devon, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK
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The prevalence, management and outcomes of coronary artery perforations during percutaneous coronary intervention in patients with or without acute coronary syndromes. Coron Artery Dis 2021; 32:610-617. [PMID: 33471469 DOI: 10.1097/mca.0000000000001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention (PCI). The aim of this study was to compare early and late clinical outcomes of CAP in patients with or without acute coronary syndromes (ACS). METHOD A retrospective review was made of the procedural records of 15 878 patients who underwent PCI at two large tertiary centers between January 2012 and December 2018. A total of 51 (0.32 %) CAP cases were identified. RESULTS Of the 51 CAP cases, 26 (51.0%) patients had ACS and 25 (49%) patients had stable coronary artery disease (CAD). The major cause of perforation was stenting (43%). Cardiac tamponade was more frequent in the ACS group than stable CAD group (34.6 vs. 8%; P = 0.024). Kaplan-Meier analysis showed that the overall 30-day cardiovascular mortality rate was higher in patients with ACS than stable CAD (23.1 vs. 0%; P = 0.011). At the 3-year follow-up examination, no statistically significant difference was determined between the two groups in respect of all-cause mortality (36.1 vs. 28.4%; P = 0.262). Multivariable Cox regression analysis demonstrated left ventricular ejection fraction (hazard ratio, 0.94; 95% CI, 0.89-0.99; P = 0.033) but not ACS at presentation (hazard ratio, 1.39; 95% CI, 0.37-5.20; P = 0.628) as a predictor of mortality at 3 years. CONCLUSIONS Early clinical outcomes following CAP, including cardiac tamponade and 30-day cardiovascular mortality, were significantly worse in patients with ACS compared to stable CAD.
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Zhu X, Umezu M, Iwasaki K. Finite Element Analysis of the Cutting Balloon With an Adequate Balloon-to-Artery Ratio for Fracturing Calcification While Preventing Perforation. Circ Rep 2021; 3:1-8. [PMID: 33693284 PMCID: PMC7939788 DOI: 10.1253/circrep.cr-20-0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Xiaodong Zhu
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University
| | - Mitsuo Umezu
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Kiyotaka Iwasaki
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
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Moroni F, Brilakis ES, Azzalini L. Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Rev Cardiovasc Ther 2021; 19:71-87. [PMID: 33175595 DOI: 10.1080/14779072.2021.1850264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Coronary artery perforation (CAP) is an infrequent (<1%) complication of percutaneous coronary intervention (PCI), that can lead to dramatic consequences, including tamponade and death. The incidence of CAP is higher (4-9%) in chronic total occlusion (CTO) PCI due higher complexity of these lesions and the techniques used to recanalized them. AREAS COVERED In this Expert Review, we discuss the specific features of CTO PCI predisposing to CAP. We also describe the typical procedural scenarios in which CAP can occur and provide a universal management algorithm. Currently available devices and techniques for CAP treatment are presented in detail. Finally, we discuss imaging support for diagnosis of pericardial effusion in CAP as well as medical and surgical management. EXPERT OPINION With increasing volumes and complexity of CTO PCI, the incidence of CAP is likely to rise. Adherence to good catheterization laboratory practices, availability of dedicated equipment to seal CAP, perform pericardiocentesis, and provide hemodynamic support, as well as adequate training, are pillars for the prevention and optimal management of CAP during CTO PCI.
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Affiliation(s)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
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Tremmel JA. Perforation Mechanisms, Risk Stratification, and Management in the Non-post Coronary Artery Bypass Graft Patient. Interv Cardiol Clin 2020; 10:93-99. [PMID: 33223111 DOI: 10.1016/j.iccl.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer A Tremmel
- Stanford University Medical Center, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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Management of Coronary Artery Perforation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:55-60. [PMID: 33203580 DOI: 10.1016/j.carrev.2020.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors for CAP include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. There are 3 major types of CAP depending on location: (a) large vessel perforation, (b) distal vessel perforation, and (c) collateral perforation. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with coil or fat embolization. In this article we provide a state-of-the-art overview of the contemporary management of CAP.
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Birkemeyer R, Olivecrona GK, Hellig F, Wöhrle J, Rottbauer W, Witkowski A, Kuliczkowski W, Bernhardt P, Bettels N, Schrage B, von Zur Mühlen C, Cook S, Miljak T, Eggbrecht H, Eeckhout E, Westermann D, Monsegu J, Dumonteil N. Sealing of Coronary Perforations With a Second-Generation Covered Stent Graft - Results From the PAST-PERF Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:20-26. [PMID: 33132086 DOI: 10.1016/j.carrev.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The PAST-PERF registry was initiated to collect data on the PK Papyrus covered stent, a second-generation device for the treatment of coronary artery perforations with enhanced mechanical properties, but with limited available data. METHODS Patients treated for coronary artery perforations with the PK Papyrus stent at 14 international centers were retrospectively identified. The primary effectiveness outcome was successful sealing of the perforation. The primary safety outcome was a composite of all-cause mortality, definite or probable stent thrombosis, myocardial infarction and target lesion revascularization. RESULTS Among the 94 included patients, 72.3% (68/94) had Ellis type III and cavity spilling perforations. Complete sealing was achieved in 93.6% (n = 88), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). Pericardiocentesis was required in 25.0% (n = 23), emergency cardiac surgery was needed in 7.6% (n = 7), acute stent thrombosis was observed in 1.1% (n = 1), and in-hospital mortality occurred in 11.7% (n = 11). The median follow-up duration was 283 (IQR:40;670) days. At 6 and 12 months, the incidence of the primary safety endpoint was 26.6% [95%CI:18.6;37.1] and 32.0% [95%CI:22.8;43.4], mortality 15.0% [95%CI:9.0;24.6] and 19.0% [95%CI:11.3;30.0], and target lesion revascularization 5.5% [95%CI:2.0;14.6] and 7.7% [95%CI:3.1;18.2]. Two definite stent thrombosis occurred, one during the procedure and one on post-procedure day 233. CONCLUSIONS The registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. ANNOTATED TABLE OF CONTENT The PAST-PERF registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Specifically, complete sealing was achieved in 93.6% of patients (n = 88/94), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). The 12-month mortality was 19.0% [95%CI:11.3;30.0], the rate of target lesion revascularization was 7.7% [95%CI:3.1;18.2], and two definite stent thromboses occurred (one during procedure and one on post-procedure day 233).
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Affiliation(s)
| | | | | | - Jochen Wöhrle
- University Hospital Ulm, Ulm, Germany; Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Eric Eeckhout
- CHUV (Centre Hospitalier Universitaire Vaudoise), Lausanne, Switzerland
| | | | - Jaques Monsegu
- Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther 2020; 36:1-18. [PMID: 33079355 PMCID: PMC7829233 DOI: 10.1007/s12928-020-00715-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation. J Clin Med 2020; 9:jcm9093043. [PMID: 32967327 PMCID: PMC7565780 DOI: 10.3390/jcm9093043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. Methods: From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAPIII) over a 15-year period (2005-2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAPIII and without tamponade (n = 60). Results: CAPIII were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAPIII in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAPIII in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAPIII in the remaining coronary arteries (23%) (p = 0.24). However, when CAPIII in the LCx were separated from CAPIII in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAPIII in the LCx (54%, 7 of 13) compared to subjects with CAPIII in an artery other than the LCx (21%, 14 of 68) (p = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, p = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, p = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. Conclusions: CAPIII in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes.
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Protty MB, Hussain HI, Gallagher S, Al‐Raisi S, Aldalati O, Farooq V, Sharp ASP, Egred M, O'Kane P, Ludman P, Anderson RA, Mamas MA, Kinnaird T. Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv 2020; 97:E653-E660. [DOI: 10.1002/ccd.29251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Majd B. Protty
- Department of Cardiology University Hospital of Wales Cardiff UK
- Systems Immunity University Research Institute Cardiff University Cardiff UK
| | | | - Sean Gallagher
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Sara Al‐Raisi
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Omar Aldalati
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Vasim Farooq
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Andrew S. P. Sharp
- Department of Cardiology University Hospital of Wales Cardiff UK
- Department of Cardiology University of Exeter Exeter Devon UK
| | - Mohaned Egred
- Cardiothoracic Department Freeman Hospital Newcastle‐Upon‐Tyne UK
| | - Peter O'Kane
- Department of Cardiology Bournemouth Hospital Bournemouth UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences University of Keele Stoke‐on‐Trent UK
| | - Tim Kinnaird
- Department of Cardiology University Hospital of Wales Cardiff UK
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences University of Keele Stoke‐on‐Trent UK
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Kwok CS, Sirker A, Nolan J, Zaman A, Ludman P, de Belder M, Kinnaird T, Mamas MA. A National Evaluation of Emergency Cardiac Surgery After Percutaneous Coronary Intervention and Postsurgical Patient Outcomes. Am J Cardiol 2020; 130:24-29. [PMID: 32654754 DOI: 10.1016/j.amjcard.2020.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
There is limited national data regarding emergency cardiac surgery for complications sustained after percutaneous coronary intervention (PCI). This study aimed to examine emergency cardiac surgery after PCI in England and Wales and postsurgical patient outcomes. We analyzed patients in the British Cardiovascular Intervention Society database who underwent PCI between 2007 and 2014 and compared characteristics and outcomes for patients with and without emergency cardiac surgery. A total of 549,303 patients were included in the analysis and 362 (0.07%) underwent emergency cardiac surgery. There was a modest decline in the annual rate of emergency cardiac surgery from 0.09% to 0.06% between 2007 and 2014. Variables associated with emergency cardiac surgery included receipt of circulatory support (Odds ratio (OR) 39.20 95% confidence interval (CI) 27.75 to 55.36), aortic dissection (OR 28.39 95%CI 14.59 to 55.26), coronary dissection (OR 18.50 95%CI 13.60 to 25.18), coronary perforation (OR 7.86 95%CI 4.27 to 14.46), cardiac tamponade (OR 6.77 95%CI 3.13 to 14.66), and on-site surgical cover (OR 2.15 95%CI 1.56 to 2.97). After adjustments, patients with emergency cardiac surgery were at increased odds of 30-day mortality (OR 4.41 95%CI 2.94 to 6.62) and in-hospital major adverse cardiac and cerebrovascular events (OR 1.63 95%CI 1.07 to 2.48). On site surgical cover was independently associated with increased odds of mortality (OR 1.26 95%CI 1.20 to 1.33) following emergency cardiac surgery. In conclusion, emergency cardiac surgery after PCI is a rarely required procedure and in England and Wales there appears to be a decline in recent years. Patients who underwent emergency cardiac surgery have higher risk of adverse outcomes and longer length of hospital stay.
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Barbero U, Cerrato E, Secco GG, Tedeschi D, Belliggiano D, Pavani M, Moncalvo C, Tomassini F, De Benedictis M, Doronzo B, Varbella F. PK Papyrus coronary stent system: the ultrathin struts polyurethane-covered stent. Future Cardiol 2020; 16:405-411. [DOI: 10.2217/fca-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the emergency setting of a coronary vessel perforation, the knowledge of materials needed to fix it and the intrinsic quality of the device used is mandatory for the interventional cardiologist. The PK Papyrus covered stent (Biotronik AG) is an ultrathin strut (60 μm) balloon-expandable stent covered on the abluminal surface with an electrospun polyurethane matrix. It is intended to facilitate device delivery and effectively treat coronary artery perforations. In published studies, rates of successful device delivery and perforation sealing were above 90%, respectively, and most events were usually resolved with a single stent. In this review we focused on the main technical characteristics as well on the published evidence that compare its performance with other coronary covered stent.
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Affiliation(s)
- Umberto Barbero
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli & San Luigi Gonzaga, Orbassano, Turin, Italy
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Delio Tedeschi
- Interventional Cardiology, Istituto Clinico S.Anna Gruppo Ospedaliero San Donato, Brescia, Italy
| | - Davide Belliggiano
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Marco Pavani
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Cinzia Moncalvo
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Francesco Tomassini
- Interventional Cardiology, Infermi Hospital, Rivoli & San Luigi Gonzaga, Orbassano, Turin, Italy
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Nairooz R, Parzynski CS, Curtis JP, Mohsen A, McNulty E, Uretsky BF, Hakeem A. Contemporary Trends, Predictors and Outcomes of Perforation During Percutaneous Coronary Intervention (From the NCDR Cath PCI Registry). Am J Cardiol 2020; 130:37-45. [PMID: 32665131 DOI: 10.1016/j.amjcard.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023]
Abstract
Coronary artery perforation (CP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). Given the marked increase in high-risk and complex PCIs, careful review and understanding of PCI complications may help to improve procedural and clinical outcomes. Our aim was to study the trends, predictors and outcomes of CP in the contemporary era. This cross-sectional multicenter analysis included data collected from institutions participating in the National Cardiovascular Data Registry CathPCI Registry between July 2009 and June 2015. Multivariable logistic regression models were created to identify predictors of CP and compare the in-hospital outcomes of CP and non-CP patients. Of 3,759,268 PCIs performed during the study period, there were 13,779 CP (0.37%). During the study period, the proportion of PCI that developed CP remained unchanged (0.33% to 0.4%) (p for trend 0.16). Chronic total occlusion (CTO) PCI as percentage of total PCI volume increased over the study period (3% to 4%) (p for trend <0.001) with a concomitant significant increase in CTOs with perforation (1.2% to 1.5%, p for trend = 0.02). CTO PCI (Odds Ratio [OR] 2.59) female gender (OR 1.38), saphenous vein graft PCI (OR 1.2), ACC Type C lesion (1.48), cardiogenic shock on presentation (1.15), and use of atherectomy (laser/ rotational) (OR 2.38) were significant predictors of CP. CP patients had significantly higher rates of cardiogenic shock (7.73% vs 1.02%), tamponade (9.6% vs 0.05%) and death (4.87% vs 1.14%) compared with those without CP. Strongest predictors of any adverse events amongst CP were cardiogenic shock (OR 3.93), cardiac arrest (OR 2.02) and use of atherectomy device (OR 2.5). Use of covered stents was also strongly associated with adverse events (OR 3.67) reflecting severity of these CPs. CP in CTO PCI had higher rates of any adverse event than non-CTO CP (26.8% vs 22%, p < 0.001). However non-CTO CP had higher rates of coronary artery bypass grafting (CABG) (urgent, emergent, or salvage) (5.8% vs 4.5%, p = 0.03) and death (6.9% vs 5.6%, p = 0.04). CP in CABG PCI had fewer adverse events compared with those without previous CABG (16.1% vs 24.7%). In a large real world experience, we identified several clinical and procedural factors associated with increased risk of CP and adverse outcomes. The trends in CP remained constant over the study period.
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Sanz Sanchez J, Garbo R, Gagnor A, Oreglia J, Mazzarotto P, Maurina M, Regazzoli D, Gasparini GL. Management and outcomes of coronary artery perforations treated with the block and deliver technique. Catheter Cardiovasc Interv 2020; 98:238-245. [DOI: 10.1002/ccd.29241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jorge Sanz Sanchez
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Roberto Garbo
- Department of Invasive Cardiology San Giovanni Bosco Hospital Turin Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology Maria Vittoria Hospital Turin Italy
| | - Jacopo Oreglia
- Department of Invasive Cardiology Niguarda Hospital Milan Italy
| | | | - Matteo Maurina
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Damiano Regazzoli
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
| | - Gabriele L. Gasparini
- Department of Invasive Cardiology Humanitas Clinical and Research Center—IRCCS—Rozzano Milan Italy
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