Intracoronary thrombin injection using a microcatheter to treat guidewire-induced coronary artery perforation

Fischell, Tim A.; Moualla, Soundos; Mannem, Santhosh

doi:10.1016/j.carrev.2010.12.002

Cited by 21 publications

(13 citation statements)

References 18 publications

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“…Fat embolization was used in only one case in our study. Other methods including blood clot, fibrin glue, gelfoam, microspheres, silk suture, thrombin and skin embolization have also been reported in small studies . An alternative strategy, especially for small perforated vessels that cannot be engaged with a microcatheter is placement of a covered stent across the origin of the perforated vessel .…”

Section: Discussionmentioning

confidence: 99%

“…Other methods including blood clot, fibrin glue, gelfoam, microspheres, silk suture, thrombin and skin embolization have also been reported in small studies. [22][23][24][25][26][27][28] An alternative strategy, especially for small perforated vessels that cannot be engaged with a microcatheter is placement of a covered stent across the origin of the perforated vessel. 41 Heparin reversal should be avoided until after all equipment is removed from the coronary artery to minimize the risk for coronary thrombosis.…”

Section: Treatmentmentioning

confidence: 99%

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Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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Objectives We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. Background Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. Methods Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk‐adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One‐year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. Results Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22–13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in‐hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. Conclusions Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in‐hospital mortality, highlighting the importance of prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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“…Thrombin is a potent platelet activator, and it directly promotes the formation of fibrin clots. Local and precise administration of thrombin containing solutions and a commercially available glue containing thrombin and fibrinogen, administered through a microcatheter or an over‐the‐wire balloon, have been described to seal distal perforations …”

Section: Treatment Optionsmentioning

confidence: 99%

Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview

Lemmert

Bommel

Diletti

et al. 2017

JAHA

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BackgroundCoronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11‐year single‐center experience.Methods and ResultsFrom February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62.7% were male. Treated lesion type was B2/C in 94.6%, and 31.3% were chronic total occlusions. Nonworkhorse guidewires were applied in 74.3%. CAP types were Ellis type I in 2.9%, Ellis type II in 40.4%, Ellis type III in 54.8%, and Ellis type III cavity spilling in 1.9%. CAP treatment was conservative (including prolonged balloon inflation) in 73.3%. Covered stents, coiling, and fat embolization were used in 24.0%, 0.7%, and 2.0%, respectively. Pericardiocentesis for tamponade was required for 72 patients (48.0%), of whom 28 were initially unrecognized. Twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. Periprocedural myocardial infarction occurred in 34.0%, and in‐hospital all‐cause mortality was 8.0%. All‐cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year.ConclusionsCAP is a rare complication of percutaneous coronary intervention, but morbidity and mortality are considerable. Early recognition and adequate management are of paramount importance.

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“…Since the balloon is not used for the dilation of the lesion site, only a small leakage (which confines itself) is seen. However, in cases of need, thrombin is injected distally through the burst balloon used to close the leak …”

Section: Discussionmentioning

confidence: 99%