Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Danek, Barbara Anna; Karatasakis, Aris; Tajti, Péter; Sandoval, Yader; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Kandzari, David E.; Lembo, Nicholas; Patel, Mitul; Mahmud, Ehtisham; Choi, James W.; Doing, Anthony; Lombardi, William; Wyman, R. Michael; Toma, Catalin; García, Santiago; Moses, Jeffrey W.; Kirtane, Ajay J.; Hatem, Raja; Ali, Ziad A.; Parikh, Manish; Karácsonyi, Judit; Rangan, Bavana V.; Khalili, Houman; Burke, M. Nicholas; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1016/j.amjcard.2017.07.010

Cited by 72 publications

(69 citation statements)

References 27 publications

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“…Recently, with the development of low‐profile CS as well with implementation of new techniques, like the “double catheter technique” ( Figures and ), protamine use is decreasing …”

Section: Discussionmentioning

confidence: 99%

Acute and long‐term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3‐CAP registry

Pavani

Cerrato

Latib

et al. 2018

Cathet Cardio Intervent

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Background: Covered stent (CS) implantation is considered a useful device in the setting of Grade III Coronary Perforation (G3CP), one of the most harmful PCI complication. However, data regarding efficacy of this device and clinical outcomes are still limited. Methods and results: From 1993 to 2015, among 97,779 patients from 9 European centres undergoing PCI, 224 patients had G3CP (0.23%), and 102 patients were managed with CS implantation (96 with PTFE, 6 with pericardium). Device oriented composite endpoint (DOCE), a composite of cardiac death, target lesion revascularization, and stent thrombosis (ST) in-hospital and at long term follow-up were evaluated. G3-CP perforations were successfully sealed with CS in 88 patients (86.3%) with need of intraprocedural pericardiocentesis in one-third of cases.Protamine as heparin reversal agent was administered in 36 (35%) of cases. The cumulative incidence of in-hospital DOCE were 16.6% (17/102): death 14.7%, TLR 2.9%, ST 3.9%. At longterm follow-up (mean 42 AE 38 months), DOCE rates occurred in 19.7%: death 7.4%, TLR 11%, and ST 6.2%. Indication to Dual Antiplatelet Therapy (DAPT) was lifelong in 20% of cases, 1 to 6 months in 22.5% and 12-months in 57.5% without differences in long-term DOCE before and after DAPT interruption (8.0 vs. 6.6%, respectively, P = 0.20).Conclusions: Use of CS was successful in sealing grade 3 coronary artery perforations in the majority of cases. Beside the high rate of clinical events at short and long-term, ST remains the leading cause of device failure. K E Y W O R D Saneurysm/dissection/perforation, complications, CORD-coronary, coronary artery disease, percutaneous coronary intervention, stent fracture/failure, stent thrombosis

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“…Recently, with the development of low‐profile CS as well with implementation of new techniques, like the “double catheter technique” ( Figures and ), protamine use is decreasing …”

Section: Discussionmentioning

confidence: 99%

Acute and long‐term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3‐CAP registry

Pavani

Cerrato

Latib

et al. 2018

Cathet Cardio Intervent

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“…Coronary perforations (CPs) are one of the most common and serious complications occurring during CTO PCI. They have an estimated incidence of 2.6%-4.8% [2][3][4][5][6] and are associated with a 5-fold increase in 30-day mortality. Cardiac tamponade occurs in approximately 10% of patients with a coronary perforation and could represent a life-threatening situation.…”

Section: Coronary Perforationmentioning

confidence: 99%

Chronic total occlusion percutaneous coronary intervention complications: prevention and management

Colombo¹,

Bernardi²,

Garbo³

2019

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Percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTO) still represents a challenge in the field of interventional cardiology. Despite the rate of peri-procedural complications has decreased over the years, it remains higher than in non-CTO PCI. Coronary perforations are among the most common and serious complications. Furthermore CTO recanalization carries a risk of unique and specific complications such as donor vessel injury and equipment loss or entrapment. Other infrequent complications of non-CTO PCI such as contrast induced renal dysfunction and radiation skin injury, assume more relevance in this subset given the length and complexity of these procedures. Operators facing CTO percutaneous treatment should be aware of the potential complications and the available strategies for prevention and management, to achieve procedural success.

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“…50 In another multicenter registry, the incidence of perforation among 2097 CTO PCIs was 4.1%, but only 0.6% required pericardiocentesis. 51 Coronary perforation in patients who underwent prior CABG had been considered less perilous previously, because pericardial adhesions form after sternotomy, potentially preventing tamponade. Recent reports, however, suggest that perforation in patients who underwent prior CABG may result in loculated hematomas, potentially causing localized tamponade and cardiogenic shock.…”

Section: Perforationmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Cited by 72 publications

References 27 publications

Acute and long‐term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3‐CAP registry

Acute and long‐term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3‐CAP registry

Chronic total occlusion percutaneous coronary intervention complications: prevention and management

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

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