Incidence, Risk Factors, Management and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention

Shimony, Avi; Zahger, Doron; Straten, Michael van; Shaleṿ, Aryeh; Gilutz, Harel; Ilia, Reuben; Cafri, Carlos

doi:10.1016/j.amjcard.2009.07.048

Cited by 139 publications

(129 citation statements)

References 15 publications

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“…Additionally, in this study, the superiority of covered stent implantation over prolonged balloon inflation in reaching haemostasis was shown, and multiple methods of treatment were required in an attempt to achieve haemostasis in 39.3% 4 of patients. Grade III is the most dangerous form of perforation, associated with rates of cardiac tamponade as high as 40%, and the need for emergency CABG is reportedly between 20% and 40% 5,6 . In our case, we did not manage to achieve adequate haemostasis by prolonged balloon inflation; therefore, prompt implantation of a PTFE stent, along with a pericardial drain, was required to resolve this iatrogenic complication.…”

Section: Discussionmentioning

confidence: 99%

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Srećković

Jagić

Miloradović

et al. 2014

Serbian Journal of Experimental and Clinical Research

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ABBREVIATIONS PCI-percutaneous coronary interventionPTFE-polytetrafluoroethylene NSTEMI-non ST segment elevation myocardial infarction LVH-left ventricular hypertrophy LAD-left anterior descending artery D1-first diagonal branch S1-first septal branch RCA-right coronary artery SC-semi compliant balloon DES-drug eluting stent BMS-bare metal stent CPR-cardiopulmonary resuscitation CABG-coronary artery bypass graft CASE REPORTA 68 year old female was admitted to the cath lab due to complaints of postinfarction angina. She suffered an anterior NSTEMI 5 months prior to presentation. Her risk factors for cardiovascular disease were as follows: hypertension, diabetes, dyslipidemia, and a history of smoking. An electrocardiogram showed sinus rhythm, with a rate of 75 bpm, as well as signs of LVH and a reduced R in V2. Echocardiography revealed a reduced ejection fraction -40% and anterior wall hypokinesia. Angiography was performed, showing that the LAD was diffusely atherosclerotic and calcified, with tight stenosis approaching 90% of the vessel lumen immediately after the D1 and S1 branches (Figure1).

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Section: Discussionmentioning

confidence: 99%

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Srećković

Jagić

Miloradović

et al. 2014

Serbian Journal of Experimental and Clinical Research

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“…Several patient-related risk factors have been found to be associated with the development of CAP, including older age, female gender, hypertension, history of heart failure, lower creatinine clearance and prior use of antithrombotic agents [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention

Yorgun¹,

Canpolat²,

Aytemir³

et al. 2012

Cardiol J

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“…It has been demonstrated that the type of the guide wire used, the balloon/vascular diameter ratio and oversize stent are the factors for the de-velopment of perforation [3,10]. It is life-saving that the cardiologist performing the invasive procedure is competent and aware of this complication, avoids this complication and has accurate knowledge about how should act when this complication occurs [11]. The choice of large balloon, and high inflation pressure may result in perforation [12,13].…”

Section: Introductionmentioning

confidence: 99%

Fatal complication, rescue therapy; covered stent for coronary artery perforation

Yıldız¹,

Karakurt²,

Bitigen³

et al. 2013

Health

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Introduction: Although coronary perforation is a rare complication observed during intervenetional procedures, it has a considerably high mortality rate. The prevelance of coronary perforation has been reported to be 0.20% -0.6%. Its sudden development, the patient's agitation and development of rapid collapse render intervention difficult. Materials and Method: The presence of perfusion balloon and covered stent in clinics is life-saving. In the present study, we retrospectively reviewed 17 cases with coronary artery perforation that were treated between 2009 and 2012. Of these patients, 10 (58.8%) were men and 7 (41.2%) were women; the median age was 62.8 ± 8.3 years. The coronary artery perforation resulted from guide wire in 23.5%, balloon dilatation in 58.8% and stent implantation in 17.6%. All the lesions were either type B or C lesions. Results: The extensiveness of perforation was Ellis grade I in 23.5%, grade II in 47.1% and grade III in 29.4% of the cases. In the treatment of the perforation, polytetrafluoroethylene-covered stent graft was implemented in 9 (52.9%) patients, whilst conventional and emergency surgical therapy was performed in 8 (47.1%) patients. Grade I perforations occurred due to the guide wire and were managed with conventional therapy (p < 0.05). Grade II and III perforations resulted from balloon and stent. The majority of these patients were inserted Graft Stent (stent graft in 52.9% and conventional therapy in 23.5% of the cases (p < 0.05). Although all the stent grafts were successfully implanted, the complete control of bleeding was achieved only in 77.7% of the patients. Mortality was not observed in grade I perforation, whilst all cases resulted in mortality had grade III perforation. Conclusion: These data indicate that there is a need for further advanced technology in the coronary artery perforation despite of currently available therapeutic options.

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Incidence, Risk Factors, Management and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention

Cited by 139 publications

References 15 publications

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention

Fatal complication, rescue therapy; covered stent for coronary artery perforation

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