“Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention”

Krishnegowda, Chetana; Puttegowda, Beeresha; Krishnappa, Santhosh; Ananthakrishna, Rajiv; Mahadevappa, Nagesh C.; Siddegowda, Sadananda K.; Ramegowda, Raghu Thagachagere; Manjunath, Cholenahally Nanjappa

doi:10.1016/j.ihj.2020.07.012

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…Occasionally a badly torn coronary artery is encountered, coronary endarterectomy with CABG using a vein hood serves well [7]. Teflon felt wrapping of the vessel turns helpful when multiple stent cause perforation [9].…”

Section: Discussionmentioning

confidence: 99%

Dreaded coronary artery perforations during percutaneous coronary artery interventions

Ramesh¹,

Varadaraju²,

Chandrasena³

et al. 2022

CSIC

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Spurting coronary artery in the pericardial cavity is observed rarely. Pericardial tamponade occurs and myocardial salvaging time starts ticking. Coronary artery perforations (CAP) have been quoted in literature to range from 0.1 % to 0.7 % of percutaneous coronary artery intervention (PCI) cases. Data was collected retrospectively from the patients of Sri Jayadeva Institute of Cardiovascular Sciences and Research in 2012-2019. A total of 2556 PCI were found in our database of which emergency surgical intervention were needed in 4 patients (0.15 %). Decision making in type 3 CAP with hemodynamic instability is highlighted. Although covered stents and balloons are used to stem the leak, importance of an on call cardiac surgeon cannot be exemplified if the situation is not under control.

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Section: Discussionmentioning

confidence: 99%

Dreaded coronary artery perforations during percutaneous coronary artery interventions

Ramesh¹,

Varadaraju²,

Chandrasena³

et al. 2022

CSIC

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“…If unable to differentiate based on these parameters, a fourth investigator (PMik) would select between the papers with the article providing most data regarding our secondary objectives being selected for inclusion. Sixty-seven papers were included in the final statistical analysis4–7 10–72 (figure 1). Efforts to exclude data pertaining to CTO procedures within a larger dataset were made by the authors.…”

Section: Methodsmentioning

confidence: 99%

Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis

et al. 2022

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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).MethodsProspective 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.Results3997 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%.ConclusionCoronary 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 numberCRD42020207881.

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“…IIICS (CavitySpilling) тип -перфорация диаметром 1 мм и более с выходом контрастного вещества за пределы стенки артерии; перфорация в анатомическую полость (до 63 % риск тампонады) [2]. Таким образом, при выявлении экстравазации эндоваскулярному хирургу необходимо определить тип разрыва и, учитывая морфологию сосуда и гемодинамические параметры, выбрать тактику дальнейшего лечения [6][7][8][9].…”

Section: клинический случай введениеunclassified

Stent-Graft Treatment of Anterior Interventricular Artery Extravasation Type IIICS: a Clinical Case

Loginov

Файзуллин

Шакуров

et al. 2021

Kreativnaâ hirurgiâ i onkologiâ

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Введение. Каждое чрескожное коронарное вмешательство (ЧКВ) потенциально может привести к грозным осложнениям, которые могут возникать в ходе операции. Рутинные манипуляции катетером, различными провод никами, системой доставки и стентом могут повредить стенку сосуда, вследствие чего незамедлительно развивается такое осложнение, как экстравазация. По данным интервенционных кардиологов, разрывы про исходят в 0,19-0,93 % случаев ЧКВ. Эндоваскулярный хирург, столкнувшийся с данным осложнением во время операции, должен незамедлительно проанализировать ситуацию и принять решение о дальнейших действиях, чтобы устранить разрыв коронарной артерии. Материалы и методы. В данной статье приведен клинический пример осложнения при ЧКВ -экстравазация IIICS типа при рутинном стентировании передней межжелудочковой артерии. С учетом и анализом всех факто ров было принято решение имплантировать стентграфт в зоне перфорации.Результаты и обсуждение. При выполнении чрескожного коронарного вмешательства необходимо быть готовым к любым осложнениям, исключением не являются и рутинные интервенции. Такое осложнение, как экстраваза ция, является прогнозируемым. Эндоваскулярный хирург должен обладать достаточным опытом для принятия решения и определения тактики дальнейших действий. Результат после имплантации стентграфта является удовлетворительным.Заключение. При возникновении осложнений во время ЧКВ в виде экстравазации IIICS типа методом выбора может стать имплантация стентграфта.

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“Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention”

Cited by 9 publications

References 34 publications

Dreaded coronary artery perforations during percutaneous coronary artery interventions

Dreaded coronary artery perforations during percutaneous coronary artery interventions

Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis

Stent-Graft Treatment of Anterior Interventricular Artery Extravasation Type IIICS: a Clinical Case

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