Coronary artery perforation complicating percutaneous coronary intervention

Abstract

Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.

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

“…The process of study selection is shown in Figure 1. From a total of 319 studies in our search, only 29 reports were included in the analysis 6,8–35 . The description of the included studies is shown in Table 1.…”

Unrecognized perforation into the anterior interventricular vein complicating PCI for anterior STEMI: An unexpected detour

“…Coronary artery perforation represents a rare, but potentially fatal complication surrounding PCI 5 with the most common etiology being guidewire manipulation into the extravascular space 6 . Management strategies for treating CAP must rely first upon hemodynamic stabilization 7 .…”

Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis

“…If unable to differentiate based on these parameters, a fourth investigator (PMik) would select between the papers with the article providing most data regarding our secondary objectives being selected for inclusion. Sixty-seven papers were included in the final statistical analysis4–7 10–72 (figure 1). Efforts to exclude data pertaining to CTO procedures within a larger dataset were made by the authors.…”