Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment

Staged revascularization in patients with acute coronary syndromes due to saphenous vein graft failure and chronic total occlusion of the native vessel: A novel concept

“…Native coronary artery PCI, however, can be challenging and often involves treatment of CTOs, which requires technical expertise, equipment availability, and carries a risk for complications, such as perforation, which can cause loculated effusions and death in the prior CABG patients . Moreover, native coronary arteries in prior CABG patients are often heavily calcified and tortuous .…”

“…2 Native coronary artery PCI, however, can be challenging and often involves treatment of CTOs, which requires technical expertise, equipment availability, and carries a risk for complications, such as perforation, which can cause loculated effusions and death in the prior CABG patients. 15 Moreover, native coronary arteries in prior CABG patients are often heavily calcified and tortuous. 8,[16][17][18] CTO PCI in the prior CABG patients often requires use of the retrograde approach and has been associated with lower technical success but similar major adverse cardiac events rates as compared with patients without previous CABG.…”

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

“…Recent reports, however, suggest that perforation in patients who underwent prior CABG may result in loculated hematomas, potentially causing localized tamponade and cardiogenic shock. In such cases, computed tomography–guided drainage or surgical intervention may be required to drain the effusion 52, 53, 54. Intramural bleeding should be suspected if the clinical picture is suggestive of pericardial tamponade, but no pericardial effusion can be detected by echocardiography 55…”

Editorial: Retrograde via epicardial collaterals: With power comes responsibility

“…Fifth, very few (approximately 6%) of the present study patients had prior coronary bypass graft surgery (CABG) in contrast to US registries in which approximately 1 in 3 patients have prior CABG . Perforation in prior CABG patients carries increased risk for complications, because loculated effusions may develop causing localized tamponade that can be lethal as it cannot be treated with pericardiocentesis but requires surgical or computed‐tomography‐guided drainage . Therefore, the threshold for attempting retrograde CTO crossing via epicardial collaterals in prior CABG patients should be high.…”