Management of guidewire‐induced distal coronary perforation using autologous fat particles versus coil embolization

Shemisa, Kamal; Karatasakis, Aris; Brilakis, Emmanouil S.

doi:10.1002/ccd.26542

Cited by 28 publications

(18 citation statements)

References 13 publications

(14 reference statements)

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“…In a recent large US study by Parsh et al, covered stents were used in 11.2% of cases, and use of covered stents was associated with higher mortality (likely because they were used in more severe perforations). 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 .…”

Section: Discussionmentioning

confidence: 92%

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: 92%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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“…Neurovascular coils (such as the Axium coils (Medtronic, Minneapolis, MN) can be delivered through standard 0.014 microcatheters and should be available in laboratories performing complex retrograde CTO PCI procedures. Fat is another option that is universally available and can also be delivered through 0.014 microcatheters . If thrombin it selected, a very small amount should be administered with extreme care to not spill into the coronary artery, potentially causing thrombosis of the main coronary branch…”

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confidence: 84%

Editorial: Retrograde via epicardial collaterals: With power comes responsibility

Tajti

Brilakis

2018

J Interven Cardiology

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“…Subsequent treatment depends on the type of perforation. Large vessel perforations are usually treated with covered stents, whereas distal vessel or collateral vessel perforation is usually treated with fat or coil or occasionally thrombus embolization . Covered stent delivery can, however, be challenging due to high crossing profile and low flexibility, especially through tortuous and calcified vessels, which are more prone to development of perforations.…”

Section: Introductionmentioning

confidence: 99%

An alternative treatment strategy for large vessel coronary perforations

Xenogiannis

Tajti

Burke

et al. 2018

Cathet Cardio Intervent

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The standard treatment for large vessel coronary perforations is implantation of a covered stent. Antegrade attempts for crossing a right coronary artery chronic total occlusion resulted in guidewire and microcatheter exit with pericardial bleeding. A balloon was inflated proximal to the perforation site to achieve temporary hemostasis. Retrograde crossing of the chronic total occlusion was achieved through an epicardial collateral using the reverse controlled antegrade and retrograde tracking technique. Stent implantation resulted in hemostasis, likely due to creation of a subintimal flap that sealed the perforation site. If technically feasible, subintimal recanalization can be an alternative treatment strategy for coronary perforations occurring during chronic total occlusion percutaneous coronary intervention.

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Management of guidewire‐induced distal coronary perforation using autologous fat particles versus coil embolization

Cited by 28 publications

References 13 publications

Incidence, predictors, management and outcomes of coronary perforations

Incidence, predictors, management and outcomes of coronary perforations

Editorial: Retrograde via epicardial collaterals: With power comes responsibility

An alternative treatment strategy for large vessel coronary perforations

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