Coil Embolization for Coronary Artery Perforation: A Retrospective Analysis of 110 Patients

Abstract

Objective. Coil embolization (CE) for coronary artery perforation (CAP) has not been thoroughly evaluated. This study aimed to evaluate the extent of myocardial damage and impact on cardiac function after CE for CAP. Methods. A total of 110 consecutive patients treated with CE for CAP were retrospectively identified. The degree of myocardial damage and impact on cardiac function were evaluated. Results. Forty-nine (44.5%) cases involved chronic total occlusions. A guidewire was the cause of perforation in 97 (88.2%) patients. The success rate of CE was 98.2%. Almost all patients were prescribed either antiplatelet drugs or anticoagulant medication or both. Patients with perforation types III and IV were found to be prone to creatinine kinase (CK) elevation and epicardial main vessel perforation, thereby causing myocardial damage. No changes were noted in the ejection fraction (EF) in patients with type V distal perforation and collateral channel perforation, while patients with perforation of the epicardial main vessel may show impaired cardiac function afterward. Conclusions. CE is safe and effective for treating CAP, especially when collateral channels and distal vessels are involved. Meanwhile, efforts should be taken to prevent CAP in epicardial main vessels since it may be difficult to treat with CS and cause myocardial damage when bailed out with CE leading to vessel sacrifice. We found that it was not necessary to change the anticoagulant regimen after CE owing to its ability to achieve robust hemostasis.

Double set up technique as a bailout of diagonal branch coronary perforation: a case report

“…CSs are effective as a viable treatment, particularly in scenarios involving larger vessels or type III blow-out perforations, often obviating surgical intervention and potentially preserving lives. 13 Nevertheless, in cases where perforations occur in smaller vessels, involve significant side-branch vessels, or manifest distally, CSs have not shown any functionality. In such instances, CE has proven to be feasible and efficacious.…”

Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective?

“…Therefore, in this case, the decision was made to implant another DES. The Synergy Megatron DES was selected for this purpose due to its advantageous characteristics, such as the highest strut density among available stents, optimized and uniform scaffolding at larger diameters, and superior radial and axial strength (facilitated by a 12-peak design), which yielded positive results [21,24,25]. This strategy was chosen because covered stents were not available at the center where the procedure was performed.…”

Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)—Multicenter Study

“…Other advantages of the CBT include a fixed guidewire position, the opportunity to use several pieces of the cut balloon until the bleeding stops and the utilization of previously used balloons (Figures 3-5). Finally, no special or expensive equipment, such as microcatheters and coils, not to mention exceptional operator experience, are required [8]. Other advantages of the CBT include a fixed guidewire position, the opportunity to use several pieces of the cut balloon until the bleeding stops and the utilization of previously used balloons (Figures 3-5).…”

“…In brief, the previously expanded balloon (semi-compliant or noncompliant) should be cut between the markers. Next, the resulting umbrella-shaped cut remnant of the balloon is put on the coronary wire and placed in the distal part of the perforated vessel by pushing it forward with a second non-fragmented (new) balloon catheter [8]. The schematic illustration of CBT is shown in Figures 1 and 2.…”

“…The management of distal perforations relies on the immediate hemodynamic stabilization (if necessary) and sealing of the perforation with the use of coils, thrombin, clot, fat, glue or spongostan [4,[6][7][8]. Notably, while most of these specialized materials are not commonly available and require microcatheters for targeted deployment, there is an unmet need for a universal and simple treatment option for distal coronary perforation.…”