Coronary Perforation During Percutaneous Coronary Intervention Lessons From Our Experiences

Abstract

SUMMARYCoronary perforation is an undesirable complication during percutaneous coronary intervention (PCI). We reviewed the cases of overt coronary perforation in our institute and analyzed their clinical backgrounds, the characteristics of the target lesion, management, and clinical outcomes. Between 1991 and 2005, we experienced 12 cases (0.35%) of coronary perforation in a total of 3415 PCI procedures. The perforation occurred during the use of debulking devices in 3 cases, immediately after stenting in 2, immediately after postdilatation of the stent in 2, and during wiring in 3 cases. Restoration was attempted by long inflation of a balloon in 7 cases, implantation of a covered stent graft in 1, and emergency surgical repair in 1 case. Subsequent cardiac tamponade occurred in 3 patients who required pericardiocentesis, and 1 patient died due to congestive heart failure. Administration of protamine was effective in stopping the bleeding in 6 patients, whereas continuation of antiplatelet therapy resulted in no overt rebleeding. Coronary perforation during PCI is a rare complication but is associated with significant morbidity and mortality. Intravenous administration of protamine is effective when it is used in conjunction with nonsurgical devices for initial management of perforation. (Int Heart J 2007; 48: 1-9)

Direct Stenting Versus Predilatation and Stenting Technique When Using Paclitaxel-Eluting Stents

“…Fluoroscopy time was 15.5 ± 7.6 minutes in the predilatation group and 10.6 ± 7.8 minutes in the direct stenting group (P < 0.0001). Although the incidence of coronary perforation has been reported recently to be as much as 0.35%, 13) there were no cases of coronary perforation, abrupt closure, or stent dislodgement in our single center experience. Transient angiographic no reflow that was rapidly reversed by the use of an intracoronary bolus injection of verapamil was observed in 8 lesions in the predilatation group and in two lesions in the direct stenting group (P = NS).…”

A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

“…When the risk associated with the surgical procedure is considered to be higher than that with the restenosis or reocclusion of the covered stent, or when an emergent operation cannot be performed, this method is considered to be valuable. 13) In this case, we diagnosed coronary artery hematoma in a patient with hyperechoic mass at right atrioventricular groove on TTE after failed PCI for chronic total occlusion of right coronary artery. Although there were no myocardial blush or extravasation in coronary angiogram, echocardiographic finding of hyperechoic mass suggestive of right coronary hematoma meant existence of extravasation due to coronary perforation.…”

“…If TTE shows the presence of a pericardial fluid and sufficient pericardial space for safe centesis, pericardiocentesis must be carried out. 13) If abovementioned methods fail, emergency CABG should be considered.…”

Successful management of Ellis type III left anterior descending artery perforation following percutaneous coronary intervention by a covered stent: Successfully resolved the dramatic complication

“…4 Grade III CP is defined by the Ellis criteria as a perforation resulting in extravasation of blood …”

“…5 The incidence of grades I to III coronary perforation range from 0.1% to 3.0%. 4 The key risk factors which are considered to predispose to the causation of perforation are advanced patient age, female gender and the use of ablative devices. 6 Grade III CP is the most serious form of perforation with a high incidence of mortality rates which may range from 7% to 44% of cases.…”