Coronary Artery Perforation

Abstract

Percutaneous coronary intervention (PCI) is considered as the standard treatment of obstructive coronary artery disease in indicated patients. Even though PCI gives symptomatic angina improvement, but associated with serious complications like coronary artery perforation (CAP), the incidence is quite low. With the more complex lesions for successful angioplasty, different devices are required, which in turn increase the incidence of CAP in these patients. Here we review the classification, incidence, pathogenesis, clinical sequela, risk factors, predictors, and management of CAP in the current era due to PCI.

Iatrogenic Pericarditis and Cardiac Tamponade Following Distal Wire Perforation: A Serial Case Report

“…3 Furthermore, the lack of meticulous attention to the tip of GW during the procedure and the use of intracoronary imaging might increase the risk of perforation. 3,5 Our cases were complex and prolonged procedures, using more than 1 GW and intracoronary imaging, which all increased the risk for DWP.…”

“…Observation for 48 to 72 hours with repeated echo evaluation is needed. 5 There are several methods to prevent distal wire perforation, including making a loop in the distal portion of the wire to keep it in the main large vessel (reduce the risk of wire dislodgement into small branches), exchange the stiff wire for workhorse wire after crossing the lesion, be aware of the distal tip of the wire at all the times and always take the shots to look at the distal end after the wire has been retracted. 4,6 Although rare, DWP may damage mesothelial cells and blood in the pericardial space, initiating an autoimmune response, triggering cardiac antigen-antibody production, immune complex deposition in the pericardium, and producing inflammation.…”

The Closure of Grade 1 Coronary Perforation by the Snowplow Phenomenon

“…As the coronary perforation was very small (grade 1), the patient was hemodynamically stable without much pericardial effusion. Large coronary perforations are usually managed with covered stents, whereas small coronary perforations are managed with heparin reversal with protamine, prolonged balloon inflation, coiling [ 2 ], gel foam closure [ 3 , 4 ], or glue [ 5 ]. As a large covered stent was not available, we planned to deploy a conventional DES to cover the distal lesion followed by prolonged balloon inflation if the bleeding continues post-heparin reversal.…”

Hemopericardium after coronary artery stenting: clinical observations and literature review

“…Более систематизированно факторы риска и предикторы разрывов КА представлены в работах М.О. Логинова и др., C. Krishnegowda et al, T. Dep et al [12,14,15]. В работе М.О.…”

“…Логинова и др. [12] Хирургия стентирование пораженного участка с целью закрытия места диссекции с последующим мониторированием диссекции и состояния пациента [13,15]. Однако данный вопрос подлежит изучению, поскольку в настоящее время крупных исследований по этой теме для комплексной оценки проблемы еще недостаточно [9,13].…”