Guidewire‐induced coronary artery perforation treated with transcatheter delivery of subcutaneous tissue

Abstract

In three cases of small coronary artery perforation by guidewires during percutaneous coronary intervention, coronary leakage continued despite prolonged balloon inflation and reversal of heparin. Subcutaneous tissue was selectively delivered to perforated vessels by means of microcatheters in a successful attempt to stop leakage. This method appears to be extremely effective for treating guidewire-induced perforations of distal coronary arteries.

Guidewire‐Induced coronary perforation successfully treated with subcutaneous fat embolisation: A simple technique available to all

“…Subcutaneous fat, however, is universally accessible in every patient undergoing PCI and can be easily collected and delivered to the point of bleeding in a timely manner. Oda et al have previously described the use of subcutaneous tissue in sealing wire perforations . Their delivery technique to the target vessel differed from ours in that they advanced a microcatheter to the site of the perforation and then delivered the subcutaneous tissue by advancing a guidewire into the microcatheter.…”

A unique complication of the retrograde approach in angioplasty for chronic total occlusion of the coronary artery

“…Subcutaneous tissue embolization used to achieve hemostasis for coronary artery perforation in this retrograde approach might also be useful for such occurrences in the antegrade approach. Distal coronary artery perforation during PCI of the antegrade approach has been treated by this procedure in a previous report [10]. The advantages of using subcutaneous tissue as an embolization material are the ability to use at any time, short preparation time, low cost, and no requirement to reverse heparin.…”

Wire Induced Coronary Perforation Finally Terminating into Contained Myocardial Rupture – A Case Report

“…Attempts to closure of the bleeding vessel can be made using prolonged balloon inflation alone or embolization of microcoils, thrombus, fat particles, or intra arterial glue as described by earlier [1][2][3][4][5][6][7][8][9].…”

“…These are also the commonest cause for an overlooked perforation during the procedure, the leak being slow, and patient presenting with pericardial effusion and tamponade only in the post procedure period once he/she is shifted to the ward. Nearly half of these are self terminating with medical management and the other half require a closure of the leaking twig using micro coils, thrombus, fat particles, glue or otherwise [1][2][3][4][5][6][7][8][9]. Interventional management is usually successful except in rare cases.…”