Coronary artery perforation in a patient with STEMI and a myocardial bridge: an increased risk for coronary artery perforation?

Becher, Tobias; Baumann, Stefan; Huseynov, Aydin; Behnes, Michael; Borggrefe, Martin; Akın, İbrahim

doi:10.1016/j.carrev.2015.03.004

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…The Graftmaster stent graft is indicated in repair of coronary artery perforation and is contraindicated in cases where treatment area is limited to allow full balloon dilation or placement of the stent graft. Previous cases have reported perforation of the bridged segment of coronary artery into the right ventricle and the pericardial space (Table 1 [ 2,3,[13][14][15][16][17][18][19][20]). We here report the first case of perforation of a tunneled coronary artery into the left ventricle.…”

Section: Ali Et Al J Med Cases 2017;8(3):77-80mentioning

confidence: 99%

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

2017

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A myocardial bridge (MB) is a band of heart muscle that lies on the top of a coronary artery, instead of underneath it. This leads to tunneling of coronary artery through this segment of the myocardium which can be mechanically compressed during systole, also known as myocardial bridging. Although usually asymptomatic, it can be associated with exertional angina, acute coronary syndrome, cardiac arrhythmia or even sudden cardiac death. The utilization of percutaneous coronary intervention (PCI) of the bridged segment to ameliorate vessel compression and normalize blood flow is limited due to concerns of complications, particularly restenosis and perforation. Although conventional management of coronary perforation includes prolonged balloon dilation and reversal of anticoagulation, stent grafting of these perforations is not uncommonly utilized. We report a case of a patient with symptomatic MB who underwent a PCI of the bridging segment of the left anterior descending (LAD) coronary arterywhich was complicated with a perforation into the left ventricle. As patient became symptomatic, the perforation was emergently repaired using a Graftmaster ® RX coronary stent graft system (Abbott Vascular) with complete alleviation of symptoms and successful radiographic resolution.

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Section: Ali Et Al J Med Cases 2017;8(3):77-80mentioning

confidence: 99%

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

2017

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“…[3][4][5] Stent implantation into MB, due to the high rate of stent restenosis, 6,7) coronary artery perfora-tion, stent fracture, and other problems, has been questioned. [8][9][10] Vessels proximal to MB, since the long-term hemodynamic changes and the resulting shear stress, are often associated with significant atherosclerostic stenosis. 11,12) Both anatomical findings and intravenous ultrasound (IVUS) studies indicated that the incidence of MB is as high as 86%.…”

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confidence: 99%

The Outcome of Percutaneous Coronary Intervention for Significant Atherosclerotic Lesions in Segment Proximal to Myocardial Bridge at Left Anterior Descending Coronary Artery

et al. 2018

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This study aimed to evaluate the efficacy of percutaneous coronary intervention (PCI) for significant atherosclerosis lesions proximal to myocardial bridge (MB) at left anterior descending coronary artery (LAD).A total of 330 consecutive patients with LAD significant stenosis, diagnosed as acute coronary syndrome (ACS), were included. Based on whether combined with MB, the patients were divided into the MB group (MB, n = 48) and non-MB group (NMB, n = 282). Drug eluting stents (DES) were successfully implanted in the stenostic segments prior to MB. All patients were followed up during the hospital stay, 30 days and 12 months after PCI, to evaluate the major adverse cardiac events (MACEs).There was no difference in the incidence of MACEs between the two groups (6.2% versus 2.1%, P = 0.254) when in the hospital. During the follow-up of 30 days and 12 months after PCI, the rate of MACEs was significantly higher in the MB group than in the NMB group (18.2% versus 6.4% and 43.8% versus 17.0%, respectively, P < 0.001). Stent restenosis occurred in four patients in the MB group; whereas, in five patients in the NMB group, the rate of stent restenosis was higher in the MB group than in the NMB group (8.3% versus 1.8%, P = 0.036). Cox proportional hazards regression analysis revealed that the presence of MB was an independent predictor of MACEs (hazard ratio (HR) = 1.781, 95% confidence intervals (95% CI) = 1.108-2.863, P = 0.017).DES implantation for significant atherosclerosis stenosis in the segments proximal to MB have higher incidence of MACEs. MB appears to be associated with a higher incidence of stent restenosis after PCI and is a significant factor in the occurrence of MACEs.

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“…The perforation has more favorable hemodynamic and clinical outcomes than perforation into the pericardial space despite the worrying angiographic appearance [1]. In the literature, there have been a few patients in whom balloon angioplasty of the LAD resulted in coronary perforation and the development of an LAD–right ventricle fistula [2–6]. Demirsoy et al .…”

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confidence: 99%

Should all coronary artery perforations be treated immediately?

Tatlı¹,

Vural²,

Tokatlı³

et al. 2016

Arch Med Sci Atheroscler Dis

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Coronary artery perforation in a patient with STEMI and a myocardial bridge: an increased risk for coronary artery perforation?

Cited by 7 publications

References 22 publications

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

The Outcome of Percutaneous Coronary Intervention for Significant Atherosclerotic Lesions in Segment Proximal to Myocardial Bridge at Left Anterior Descending Coronary Artery

Should all coronary artery perforations be treated immediately?

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