Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry)

Bauer, Timm; Boeder, Niklas; Nef, Holger; Möllmann, Helge; Hochadel, Matthias; Marco, Jean; Weidinger, Franz; Zeymer, Uwe; Gitt, Anselm K.; Hamm, Christian W.

doi:10.1016/j.amjcard.2015.07.056

Cited by 31 publications

(28 citation statements)

References 16 publications

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“…In prior studies, various clinical and angiographic factors such as age, female gender, lower BMI, chronic kidney disease, hypertension, left ventricular dysfunction, peripheral arterial disease, cardiogenic shock, use of mechanical circulatory support, previous PCI or CABG, complex (ACC/AHA type C) lesions, coronary dissection, left main PCI, CTOs, calcified lesions, use of atherectomy and intravascular ultrasound have been associated with the occurrence of coronary perforation . Similarly, in our study, complex lesions, previous PCI and low pre‐procedure TIMI flow were independently associated with coronary perforation.…”

Section: Discussionsupporting

confidence: 80%

“…Coronary perforation is an infrequent, but potentially life threatening complication of percutaneous coronary intervention (PCI), with a reported incidence ranging from 0.29% to 0.71% . There are two major types of coronary perforations: large vessel perforation and distal vessel perforation, with collateral vessel perforation being another type specific to chronic total occlusion (CTO) interventions .…”

Section: Introductionmentioning

confidence: 99%

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Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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Objectives We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. Background Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. Methods Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk‐adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One‐year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. Results Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22–13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in‐hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. Conclusions Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in‐hospital mortality, highlighting the importance of prevention.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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“…The largest published series describes 124 events, and the total literature is <1000 cases. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Given the small numbers of events per published series, it has not been possible to examine several key questions relating to the occurrence and outcomes of CP. First, it is unclear from the available evidence what the true incidence of CP is and whether its incidence increasing or decreasing.…”

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confidence: 99%

Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

Kinnaird

Kwok

Kontopantelis

et al. 2016

Circ: Cardiovascular Interventions

108

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Background-As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database, the incidence, predictors, and outcomes of CP as a complication of PCI were defined. Adjusted odds of adverse outcomes were higher in patients with CP for all major adverse coronary events, including stroke, bleeding, and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type. Conclusions-Using a national PCI database for the first time, the incidence, predictors, and outcomes of CP were defined. Methods and Results-DataAlthough CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes. (Circ Cardiovasc Interv. 2016;9:e003449.

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“…Многие факторы риска, включая пациент-и процедура-ассоциированные, влияют на вероятность развития перфорации коронарной арте-рии. Риск возрастает при увеличении сложности пораже-ния: малом размере пораженного сосуда; извилистом и кальцифицированном типе поражения В2 и С; длинном (более 10 мм) и эксцентричном поражении; хронической тотальной окклюзии коронарной артерии [3,[6][7][8][9]. Пожи-лой возраст и предшествующее аортокоронарное шун-тирование часто увеличивает риск.…”

Section: Discussionunclassified

Effect of transcatheter embolization by tissue adhesive Histoacryl in treatment of coronary artery perforation during percutaneous coronary intervention

Шермук¹,

Krestyaninov²,

Khelimskiy³

et al. 2017

PKiK

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Aim. Coronary artery perforation (CAP) is a rare but severe complication of percutaneous coronary intervention (PCI). The aim of our study was to evaluate the effect and safety of transcatheter embolization by tissue adhesive Histoacryl when treating CAP. Methods. As CAP was confirmed, the final composition of the tissue adhesive histoacryl and radiopaque agent Lipiodol was prepared. The perforated vessel was embolized by tissue adhesive Histoacryl via a micro-catheter. There were eleven patients undergoing transcatheter embolization by Histoacryl in treatment of CAP during PCI at Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology from March 2013 to February 2016, and the clinical data of these patients were collected and analyzed retrospectively. Results. The lesion morphology of the patients was classified by using the American College of Cardiology/American Heart Association Task Force classification, there were four patients with Class B2 lesions and seven patients with Class C lesions (there also were four patients with chronic total occlusion lesions). According to the Ellis classification of CAP, there were five patients with Class II perforations and six patients with Class III perforations. The causes of perforation were a guide wire (ten patients) and balloon predilation (one patient). Three patients had pericardial effusion. All of the eight patients with CAP underwent transcatheter embolization by Histoacryl. Coronary angiography confirmed that all of them had been embolized successfully. There were no severe postoperative complications. Conclusion. Transcatheter embolization by Histoacryl is an effective, safe, cheap, and easy way to treat perforation of small vessels during PCI.Received 14 September 2016. Accepted 2 February 2017.Financing: The study did not have sponsorship.Conflict of interest: Conflict of interest: Evgeny I. Kretov served as guest editor on this issue on vascular surgery. The other authors declare no conflict of interest.Author contributionsData collection and analysis: Shermuk A.A., Naryshkin I.A., Grankin D.S., Zubarev D.D., Ibragimov R.U., Baystrukov V.I. Drafting the article: Shermuk A.A., Khelimskiy D.A., Krestyaninov O.V. Critical revision: Shermuk A.A., Khelimskiy D.A., Krestyaninov O.V., Kretov E.I.

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Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry)

Cited by 31 publications

References 16 publications

Incidence, predictors, management and outcomes of coronary perforations

Incidence, predictors, management and outcomes of coronary perforations

Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

Effect of transcatheter embolization by tissue adhesive Histoacryl in treatment of coronary artery perforation during percutaneous coronary intervention

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