Advances in the treatment of coronary perforations

Xenogiannis, Iosif; Brilakis, Emmanouil S.

doi:10.1002/ccd.28205

Cited by 24 publications

(19 citation statements)

References 5 publications

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“…There are three main perforation locations: (a) large vessel perforation, (b) distal vessel perforation, and (c) collateral vessel perforation, in either a septal or an epicardial collateral ( Fig. 2; [14][15][16]). Large vessel perforations are more common than distal vessel perforations [17].…”

Section: Perforationmentioning

confidence: 99%

Complications of chronic total occlusion percutaneous coronary intervention

et al. 2020

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Chronic total occlusion percutaneous coronary interventions can be highly complex and are associated with an increased risk of complications, such as perforation, acute vessel closure (which can lead to rapid haemodynamic compromise if it involves the donor vessel), and equipment loss or entrapment. Awareness of the potential complications and meticulous attention to equipment position and patient monitoring can help minimise the risk of complications and allow prompt treatment should they occur.

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Section: Perforationmentioning

confidence: 99%

Complications of chronic total occlusion percutaneous coronary intervention

et al. 2020

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“…The direction of the blood spurts was into the gastrointestinal tract (Supplemental Video 2); we realized that the clipped portions via the gastrointestinal tract and the perforated coronary lesion were identical. Despite a long inflation with 2.0 mm balloon at the site of perforation, bleeding persisted for 10 min; therefore, GraftMaster® 2.8 × 16 mm (Abbot vascular japan, Tokyo, JA) which is a covered stent consisting of an expandable polytetrafluoroethylene sandwiched between two identical stainless steel stents, 1 was placed across segment 3 to segment 4 PD. Stenting was successfully deployed, and adequate hemostasis was achieved.…”

Section: Case Reportmentioning

confidence: 99%

Coronary artery perforation into the upper gastrointestinal cavity due to gastric ulceration

Yamanaga

Sakamoto

Kajiwara³

et al. 2020

Cathet Cardio Intervent

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An 82‐year‐old man who had previously undergone a proximal gastrectomy with jejunal interposition surgery for stomach cancer was transferred to our hospital for massive hematemesis and hypotension. His electrocardiogram showed ST‐segment elevation in lead ΙΙ, ΙΙΙ, aVF, which confirmed inferior myocardial infarction. Due to active hematemesis, upper endoscopy was performed initially. A visible vessel of gastric ulceration was discovered, and hemostasis was achieved using hemoclips. Subsequently, coronary angiography was performed since the right coronary artery (RCA) segment 4 atrioventricular (AV) was occluded. After thrombectomy and intravascular ultrasound (IVUS), 2.0 mm balloon angioplasty was done, and coronary perforation occurred. During coronary angiography, extravasation of the contrast material into the gastrointestinal cavity was noted. A covered stent was placed across segment 3 to segment 4 descending posteriorly (PD) to stop the blood supply to the perforation site of segment 4 AV. After stenting, adequate re‐hemostasis was achieved. The patient was discharged after 28 days. This is the first report of a coronary artery perforation into the gastrointestinal cavity.

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“…Coronary perforation is a rare and potentially fatal complication of percutaneous revascularization. 1 The incidence is around 0.5%, 2 and in-hospital and 5-year mortality are 8 and 47%, respectively. 2 Some of the independent factors associated with 30-day mortality are advanced age, diabetes mellitus, renal dysfunction, the use of rotational atherectomy, the use of cutting balloons, higher lesion complexity, and glycoprotein IIb/IIIa inhibitor use.…”

Section: Introductionmentioning

confidence: 98%

“…2,3 Covered stents are considered an effective bail out strategy for large vessel coronary perforation especially with a Ellis types II-III coronary perforation 4 that cannot be salvaged using a prolonged balloon inflation. 1 The most widely used covering on devices in current practice are polytetrafluoroethylene (PTFE) (Direct-Stent, BeGraft coronary stent graft system, GRAFTMASTER), polyurethane (PK Papyrus stent) and pericardium (second generation pericardial stents Aneugraft Dx stent, "Over and Under OU"-first-generation pericardial stents). 5 However, the superiority of one device over the other is difficult to determine in observational data of a rare, and life-threatening complication of PCI.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients who undergo percutaneous coronary intervention with covered stents for coronary perforation: A systematic review and pooled analysis of data

Nagaraja

Schwarz

Moss

et al. 2019

Cathet Cardio Intervent

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Objectives: This review aims to evaluate the adverse outcomes for patients after treatment with covered stents. Background: Coronary perforation is a potentially fatal complication of percutaneous coronary revascularization which may be treated using covered stents. Studies have evaluated long-term outcomes among patients who received these devices, but hitherto no literature review has taken place. Methods: We conducted a systematic review of adverse outcomes for patients after treatment with covered stents. Data from studies were pooled and outcomes were compared according to stent type. Results: A total of 29 studies were analyzed with data from 725 patients who received covered stents. The proportion of patients with chronic total occlusions, vein graft percutaneous coronary intervention (PCI), intracoronary imaging and rotational atherectomy were 16.9, 11.5, 9.2, and 6.6%, respectively. The stents used were primarily polytetrafluoroethylene (PTFE) (70%) and Papyrus (20.6%). Mortality, major adverse cardiovascular events, pericardiocentesis/tamponade and emergency surgery were 17.2, 35.3, 27.1, and 5.3%, respectively. Stratified analysis by use of PTFE, Papyrus and pericardial stents, suggested no difference in mortality (p = .323), or target lesion revascularization (p = .484). Stent thrombosis, pericardiocentesis/tamponade and emergency coronary artery bypass surgery (CABG) occurred more frequently in patients with PTFE stent use (p = .011, p = .005, p = .012, respectively). In-stent restenosis was more common with pericardial stent use (<.001, pooled analysis for first-and second-generation pericardial stents). Conclusions: Cases of coronary perforation which require implantation of a covered stent are associated with a high rate of adverse outcomes. The use of PTFE covered stents appears to be associated with more stent thrombosis, pericardiocentesis/ tamponade, and emergency CABG when compared to Papyrus or pericardial stents.

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Advances in the treatment of coronary perforations

Cited by 24 publications

References 5 publications

Complications of chronic total occlusion percutaneous coronary intervention

Complications of chronic total occlusion percutaneous coronary intervention

Coronary artery perforation into the upper gastrointestinal cavity due to gastric ulceration

Outcomes of patients who undergo percutaneous coronary intervention with covered stents for coronary perforation: A systematic review and pooled analysis of data

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