Perkütan Koroner Girişime Bağlı İyatrojenik Koroner Arter Perfosyonu Gelişen Hastaların Demografik Özelliklerinin ve Tedavilerinin Değerlendirilmesi: Tek Merkez Deneyimi

Abstract

Objective The aim of this study was to evaluate the demographic characteristics, frequency of perforation, clinical characteristics, treatment strategies and outcomes of patients who developed coronary artery perforation (CAP) during a percutaneous coronary intervention (PCI). Materials and Methods Patients who CAP during a PCI between January 2015 and January 2020 were included in the study. In this five-year period, 25 out of 10,794 patients who underwent PCI developed CAP. Outcomes were classified as cardiac tamponade, requiring urgent revascularization by bypass or PCI, in-hospital mortality, and 30-day mortality. Results In our study, frequency of CAP during PCI was 0.23%. Seventeen patients (68%) were male. The mean age of the patients was 62,52 ± 9.60 years. Eight patients had diabetes, 17 patients had hypertension and 5 patients had a history of chronic kidney disease. According to the Ellis classification system; rates of Ellis types I, II, III, and III-CS were 8 (32%), 9 (36%), 7 (28%), and 1 (4%), respectively. In 12 patients, tamponade was observed, and 7 of these patients underwent pericardiocentesis immediately, while 4 patients underwent pericardiocentesis on their follow-up (>24 hours). In three patients, type I perforation was initially unnoticed and tamponade was observed during follow-up. Six patients died in the hospital. In remaining patients, no mortality was observed within 30 days. In our study, the rates of adverse events for Ellis types I, II and III/III-CS, were as follows: cardiac tamponade, 12%, 20%, and 16%, respectively; emergency surgery, 0%, 4%, and 0% respectively; and death, 12%, 4%, and 8%, respectively. Conclusion Although CAPs are very rare, they have quite a high mortality. Interventional cardiologists should be aware of the risk for Ellis type 1 perforations, especially, because they may not be noticed during the PCI. These data should be evaluated by studies conducted with larger numbers of patients. Keywords Coronary artery perforation; percutaneous coronary intervention; graft-coated stent Öz Amaç Bu çalışmanın amacı perkutan koroner girişim sırasında koroner arter perforasyonu gelişen hastaların demografik özelliklerini, sıklığını, klinik özelliklerini, tedavi stratejilerini ve sonuçlarını değerlendirmektir. Gereç ve Yöntemler 2015 ocak ve 2020 ocak ayları arasında perkütan koroner girişim yapılması sırasında koroner arter perforasyonu gelişen hastalar çalışmaya dahil edildi. Perkütan koroner girişim yapılan 10794 hastanın 25 tanesinde koroner arter perforasyonu gelişti. Kardiyak tamponad, acil perkütan veya baypas ile revaskülarizasyon gereksinimi, hastane içi ve 30 günlük mortalite sonlanım noktaları olarak belirlendi.

Koroner Arter Perforasyonu Gelişiminde Nötrofil-Lenfosit Oranının Rolü

“…1 Koroner arter perforasyonu (KAP), PKG sırasında seyrek olarak rastlanan ancak ölümcül sonuçları olabilen bir komplikasyondur. 2 KAP'ın koroner teller, balon anjiyoplasti, ateroablatif cihaz kullanımı, stentleme ve lazer anjiyoplasti ile ilişkili olduğu bildirilmiştir. 3 Bunun yanında KAP açısından ön gördürücü durumlar; kronik tam tıkanıklıklar (KTO), kıvrımlı ve ağır kalsifiye damarlar gibi karmaşık morfolojiye sahip hedef damara ait özellikler ile ileri yaş, böbrek yetmezliği, hipertansiyon, önceki koroner arter baypas greft (CABG) ve kararsız angına pektoris veya ST yükselmesiz miyokard enfarktüsü ile başvuru gibi hastaya ait faktörlerdir.…”