Coils embolization use for coronary procedures: Basics, indications, and techniques

Loh, Shu Xian; Brilakis, Emmanuelle; Gasparini, Gabriele; Agostoni, Pierfrancesco; Garbo, Roberto; Mashayekhi, Kambis; Alaswad, Khaldoon; Goktiken, Omer; Avran, Alexandre; Knaapen, Paul; Nap, Alex; Elguindi, Ahmed; Tammam, Khalid; Yamane, Masahisa; Stone, Gregg W.; Egred, Mohaned

doi:10.1002/ccd.30821

Cited by 7 publications

(2 citation statements)

References 88 publications

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“…Coil, subcutaneous fat, autologous skin, autologous blood clots, thrombin, microspheres, collagen, gelatin sponge, polyvinyl alcohol particles, balloon fragments or the tip of wires may be used for distal embolization. [22][23][24] Commonly used delivery devices include thrombus aspiration catheters, over-the-wire (OTW) balloons or microcatheters. Microcatheters and OTW balloons are recommended to deliver embolic substances for more precise placement.…”

Section: Distal Capmentioning

confidence: 99%

Conquer coronary artery perforation with magic hands

ZOU,

LI,

WANG

et al. 2024

Journal of Geriatric Cardiology

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Coronary artery perforation (CAP) poses a significant challenge for interventional cardiologists. Management of CAP depends on the location and severity of the perforation. The conventional method for addressing the perforation of large vessels involves the placement of a covered stent, while the perforation of distal and collateral vessels is typically managed using coils, autologous skin, subcutaneous fat, microspheres, gelatin sponge, thrombin or other substances. However, the above techniques have certain limitations and are not applicable in all scenarios. Our team has developed a range of innovative strategies for effectively managing CAP. This article provides an insightful review of the various tips and tricks for the treatment of CAP. Coronary artery perforation (CAP), called "the nightmare of cath labs", refers to the contrast or blood leaking out of the vessel through tears of coronary artery. The occurrence of CAP is related to the lesion characteristics and the complexity of percutaneous coronary intervention (PCI). In uncomplicated lesions, the incidence of CAP ranges from 0.2% to 0.4%. [1] Older age, female, previous PCI, multivessel lesions, calcification, small and tortuous arteries, use of oversized balloons/stents, high inflation pressures and rotational atherectomy are considered as the risk factors. [2] CAP is more frequently encountered in chronic total occlusion (CTO) PCI with a general incidence of 4%-9% [3] and up to 15% in cases involving the retrograde approach [4] . Apart from increasing the cost of PCI, [5] CAP can result in serious complications such as cardiac tamponade, hemodynamic collapse and even death. [2] CLASSIFICATION AND CLINICAL MANI-FESTATIONSAccording to the location, CAP can be categorized into three types: large vessel perforation, distal vessel perforation and septal/epicardial collateral perforation. Large vessel perforations refer to the tearing of main coronary artery or branch with a diameter of ≥ 2 mm. This type of perforation is often a result of using oversized stents or overinflated balloons, especially in cases of tight and severely calcified lesions. Distal vessel per-forations involve the tearing of distal or small coronary artery branch with a diameter < 2 mm, commonly caused by the movement of distal guidewires like polymerjacketed guidewires. [6] The perforation of septal/epicardial collaterals usually occurs when the retrograde approach is used in CTO PCI. [4] According to angiographic imaging, Ellis, et al. [7] classified CAP into four categories: type I: a crater extending outside the lumen only; type II: pericardial or myocardial blush without a ≥ 1 mm exit hole; type III: frank streaming of contrast through a ≥ 1 mm exit hole; and type III cavity-spilling: perforation into an anatomic cavity chamber. It is important to note that some of these perforations, such as those into the left ventricle, right ventricle, or coronary sinus, do not require treatment. GENERAL PRINCIPLESOnce CAP is confirmed, it is crucial to take immediate steps to prevent furt...

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Section: Distal Capmentioning

confidence: 99%

Conquer coronary artery perforation with magic hands

ZOU,

LI,

WANG

et al. 2024

Journal of Geriatric Cardiology

View full text Add to dashboard Cite

show abstract

“…Elective indications include occlusion of aneurysms or pseudoaneurysms, occlusion of coronary AVM, branch occlusion to prevent coronary artery steal, occlusion of saphenous vein grafts following native artery percutaneous coronary intervention, and certain congenital cardiac conditions such as small patent ductus arteriosus or aortopulmonary collaterals. [ 5 ] Based on the material and coating, coils can be classified into three categories: (i) bare metal (platinum or nitinol based) coils, (ii) hydrogel-coated coils, and (iii) fibered coils. The complications related to coronary coils can be acute or chronic.…”

mentioning

confidence: 99%