Management Of Coronary Artery Perforation Research Articles

Conquer coronary artery perforation with magic hands.

Coronary artery perforation (CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the perforation of large vessels involves the placement of a covered stent, while the perforation of distal and collateral vessels is typically managed using coils, autologous skin, subcutaneous fat, microspheres, gelatin sponge, thrombin or other substances. However, the above techniques have certain limitations and are not applicable in all scenarios. Our team has developed a range of innovative strategies for effectively managing CAP. This article provides an insightful review of the various tips and tricks for the treatment of CAP.

Intra- and Postprocedural Management of Coronary Artery Perforation During Percutaneous Coronary Intervention.

Background: Little is known regarding the postprocedural management of coronary artery perforation (CAP). Methods and Results: The characteristics, outcomes, and management of 115 CAP cases among 13,453 patients undergoing percutaneous coronary intervention (PCI) between 2001 and 2017 at Miyazaki Medical Association Hospital were analyzed retrospectively. The incidence of CAP was 0.85% (25 [0.19%] coronary ruptures [CRs], 90 [0.67%] wire perforations [WPs]). The most prevalent causes of CRs and WPs were rotational atherectomy (36.0%) and polymer-jacketed wires (41.1%), respectively. Fifty-two percent of CRs were treated using prolonged balloon inflation, whereas 50% of WPs were treated through embolization. Immediate and delayed cardiac tamponade (CT) occurred in 20% and 24% of CRs, respectively, and in 2.2% and 10% of WPs, respectively. The mean (±SD) right atrial pressure (RAP) during delayed CT in the CR and WP groups was 16.0±1.2 and 14.0±3.0 mmHg, respectively. New-onset atrial fibrillation developed in 24.0% and 11.1% of patients in the CR and WP groups, respectively, whereas late-onset coronary artery aneurysm (CAA) occurred in 24.0% and 0% of patients, respectively. One-year mortality rates in patients with immediate and delayed CT were 28.6% and 20.0%, respectively. Conclusions: Special attention should be paid to delayed CT, new-onset atrial fibrillation, and late-onset CAA after CAP treatment. Continuous monitoring of RAP after CAP during PCI may be useful for the early detection of delayed CT.

Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020

Background: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey.Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients.Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%.Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.

Clinical Outcomes of Self-Made Polyurethane-Covered Stent Implantation for the Treatment of Coronary Artery Perforations.

Objectives The present study aimed to investigate the short- and long-term clinical outcomes of self-made polyurethane-covered stents (PU-CS) in patients for the management of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI). Background Coronary artery perforation is reckoned as a serious complication in PCI and associated with considerable morbidity and mortality. Covered stents have been used for treating the life-threatening CAP during PCI. But in some catheterization laboratories, no commercial CS is immediately available when there is an urgent need for CS to rescue the coronary rupture site. Methods We retrospectively identified 24 patients who underwent 31 self-made PU-CS implantations due to CAP in Zhongshan Hospital, Fudan University, from June 2015 to January 2020. Results The total procedural success rate of CS to seal the perforation was 79.2%. Nine patients (37.5%) developed cardiac tamponade, of which 8 patients (33.3%) underwent pericardiocentesis and 4 patients (16.7%) underwent cardiac surgeries. Except for 4 cardiac death cases (16.7%), none of myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) was reported during hospital stay. Data from 22 patients (91.7%) were available at 610.4 ± 420.9 days of follow-up. Major adverse cardiac events (MACE) occurred in 6 patients (27.3%), including 5 cases of cardiac death and one TLR case. Conclusions Self-made PU-CS demonstrates high rates of successful delivery and sealing of severe CAP during PCI. Although the in-hospital mortality remains high after PU-CS implantation, the long-term follow-up shows favorable clinical outcomes, indicating the feasibility of PU-CS in treating CAP.

Application of endovascular pure electrocoagulation in the management of coronary artery perforation during percutaneous coronary intervention.

Application of endovascular pure electrocoagulation in the management of coronary artery perforation during percutaneous coronary intervention.

Anaesthesia management of coronary artery perforation during Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention (PCI) is an accepted modality of treatment in patient with coronary artery disease. Coronary artery perforation is very rare but serious complication that can occur while performing PCI. We describe two cases of coronary perforation while performing PCI. In first case, coronary perforation could not be sealed with coronary stent and required emergency surgery. And in second case, we were able to seal the coronary perforation with stent and avoid surgery.Coronary artery perforation requires team approach by cardiologist, anaesthesiologist and surgeon for early recovery and good outcome.

Coronary Perforation- A Nightmare in Cath Lab

Percutaneous Coronary Intervention (PCI) is now the standard of care in patients with coronary artery disease. With advances in modern technology, the success of PCI has relatively increased, and so is its complication, specifically in complex coronary intervention. Coronary perforation is one of the most dreadful and life-threatening complications of PCI. The most vital step in the management of coronary perforation is its identification and quick action. Multiple methods for management are now recommended in the literature, but the mainstay of treatment is still prevention. This review discusses the incidence, risk factors, prevention, identification, and management of Coronary Artery Perforation (CAP).

Management and outcomes of coronary artery perforations treated with the block and deliver technique

Coronary artery perforation (CAP) is a potentially life-threatening complication during percutaneous coronary interventions (PCI) and the best strategy for its management is yet to be proved. We aimed to analyze the safety, efficacy, and long-term clinical outcomes of the block and deliver (BAD) technique, as only anecdotal cases are reported in literature. From January 2016 to January 2020, all consecutive patients treated with the BAD technique at five high-volume centers in Italy were retrospectively identified. 25 CAPs treated with the BAD technique were included. The most frequently perforated artery was the left anterior descending artery (32%) and spring-coil wires with a hydrophilic coating were the most common culprit wires (68%). Mean sealing time was 46.9 ± 60.1min, with no significant differences between CTO-PCIs and non-CTO PCIs (p=.921). Acute successful sealing of the CAP was achieved in 96% of the cases. Immediate cardiac tamponade occurred in 28% of patients, four during CTO PCI and three during non-CTO PCI (p=.55). Two patients required pericardiocentesis during hospitalization, one patient developed acute kidney injury, and one patient underwent cardiac surgery due to severe mitral regurgitation. At 1-year follow-up no significant differences were observed between groups in terms of POCE (25 vs 25%, p=.628) and its individual components. The BAD technique proved to be effective for the management of CAP, showing high successful sealing rates. Rates of in-hospital events and at 1-year follow-up did not significantly differ between patients suffering CAP during CTO revascularization or during non-CTO PCI.

Coronary Artery Perforation

AbstractPercutaneous coronary intervention (PCI) is considered as the standard treatment of obstructive coronary artery disease in indicated patients. Even though PCI gives symptomatic angina improvement, but associated with serious complications like coronary artery perforation (CAP), the incidence is quite low. With the more complex lesions for successful angioplasty, different devices are required, which in turn increase the incidence of CAP in these patients. Here we review the classification, incidence, pathogenesis, clinical sequela, risk factors, predictors, and management of CAP in the current era due to PCI.

Contemporary Management of Coronary Artery Perforation

While coronary artery perforation remains an uncommon complication of percutaneous coronary intervention, appropriate recognition, early stabilisation and definitive treatment are essential. The immediate goals are to prevent progressive haemodynamic deterioration complicating cardiac tamponade, avoid the need for surgical intervention and limit accompanying mortality. Understanding the role and utility of newer devices that may influence procedural planning and improve procedural results when these complications occur is essential to minimise morbidity and mortality.

Uncommon use of rotational atherectomy: management of coronary artery perforation

Uncommon use of rotational atherectomy: management of coronary artery perforation

Coronary artery perforation complicating percutaneous coronary intervention.

Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.

Management and outcomes of coronary artery perforations during percutaneous treatment of acute coronary syndromes.

Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. The results of 25 patients with CAP were retrospectively analyzed. Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Study of coronary artery perforation during percutaneous coronary intervention in the Cangzhou Chinese population

Objective Coronary artery perforation (CAP) is a rare, serious complication of percutaneous coronary intervention (PCI). Many studies have addressed the incidence, risk factors, and management of CAP in diff erent countries except China. The aim of this study is to determine the risk factors and types of treatment for coronary perforation occurring in patients undergoing PCI and living in the Cangzhou Chinese population.Methods and results A retrospective cohort of 12,113 patients who underwent PCI was used: 64 patients with CAP and 192 case-control patients were evaluated. Clinical data and fi ndings from coronary arteriography and PCI were analysed. Logistic regression was used to evaluate candidate risk factors for CAP. The treatments were also evaluated. The incidence of CAP in patients undergoing PCI was 0.53%, and the mortality was 7.8% (5/64). Risk factors included female gender, hypertension, non-ST-elevation acute coronary syndrome (NSTE-ACS), right coronary artery (RCA) lesion, calcifi ed lesion, and chronic total occlusion (CTO) (all P< 0.05, all OR > 1). CTO had the highest risk (OR = 5.077, P< 0.001). Patients with class I CAP underwent conservative treatment. Patients with class II CAP underwent conservative treatment or low-pressure balloon dilatation (61.1% and 22.2%, respectively). Patients with class III CAP underwent low-pressure balloon dilatation, coated-stent implantation, and emergency surgery (40.9%, 27.3%, and 22.7%, respectively).Conclusions CAP risk factors in Cangzhou Chinese patients undergoing PCI included CTO, NSTE-ACS, hypertension, calcifi ed and RCA lesions, and female gender. Diff erent treatment methods should be used according to the diff erent classes of CAP.

Successful Nonsurgical Management of Coronary Artery Perforation Aided by Implantation of a Bare Stent

Coronary artery perforation complicating percutaneous transluminal coronary angioplasty (PTCA) is rare but can be potentially fatal. We report a case of coronary artery dissection and perforation during PTCA that was successfully treated by implanting a bare stent with disappearance of angiographic contrast extravasation and performing one-time pericardiocentesis for unexpected, delayed cardiac tamponade thereby avoiding the need for surgery. The possibility of coronary angiography not detecting a small residual leak from the perforation is also discussed. (J Interven Cardiol 2000; 13:45–50)