Management and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention

Javaid, Aamir; Buch, Ashesh N.; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Lindsay, Joseph; Pichard, Augusto D.; Waksman, Ron

doi:10.1016/j.amjcard.2006.04.032

Cited by 155 publications

(137 citation statements)

References 13 publications

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“…Additionally, in this study, the superiority of covered stent implantation over prolonged balloon inflation in reaching haemostasis was shown, and multiple methods of treatment were required in an attempt to achieve haemostasis in 39.3% 4 of patients. Grade III is the most dangerous form of perforation, associated with rates of cardiac tamponade as high as 40%, and the need for emergency CABG is reportedly between 20% and 40% 5,6 . In our case, we did not manage to achieve adequate haemostasis by prolonged balloon inflation; therefore, prompt implantation of a PTFE stent, along with a pericardial drain, was required to resolve this iatrogenic complication.…”

Section: Discussionmentioning

confidence: 99%

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Srećković

Jagić

Miloradović

et al. 2014

Serbian Journal of Experimental and Clinical Research

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ABBREVIATIONS PCI-percutaneous coronary interventionPTFE-polytetrafluoroethylene NSTEMI-non ST segment elevation myocardial infarction LVH-left ventricular hypertrophy LAD-left anterior descending artery D1-first diagonal branch S1-first septal branch RCA-right coronary artery SC-semi compliant balloon DES-drug eluting stent BMS-bare metal stent CPR-cardiopulmonary resuscitation CABG-coronary artery bypass graft CASE REPORTA 68 year old female was admitted to the cath lab due to complaints of postinfarction angina. She suffered an anterior NSTEMI 5 months prior to presentation. Her risk factors for cardiovascular disease were as follows: hypertension, diabetes, dyslipidemia, and a history of smoking. An electrocardiogram showed sinus rhythm, with a rate of 75 bpm, as well as signs of LVH and a reduced R in V2. Echocardiography revealed a reduced ejection fraction -40% and anterior wall hypokinesia. Angiography was performed, showing that the LAD was diffusely atherosclerotic and calcified, with tight stenosis approaching 90% of the vessel lumen immediately after the D1 and S1 branches (Figure1).

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Section: Discussionmentioning

confidence: 99%

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Srećković

Jagić

Miloradović

et al. 2014

Serbian Journal of Experimental and Clinical Research

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“…In our case also guide wire was in false lumen. However, in most cases, it does not result in tamponade, unlike our case, and can be managed conservatively [7]. In patients where extravasation is located in the wall of epicardial artery, stent-graft can be used effectively to cover the perforation [8].…”

Section: /5mentioning

confidence: 99%

Dangerous Complication of Percutaneous Coronary Intervension (PCI) of Coronary Complete Total Occlusion (CTO) Managed by Complete Total Occlusion (CTO)

Saha¹,

Ete²,

Dorjee³

et al. 2016

OALib

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Patients having chronic total occlusion (CTO) of coronary artery who have inadequate collaterals to provide sufficient blood flow to the myocardial bed may present with anginal symptoms. Revascularisation of myocardium can be considered in those patients who remain symptomatic despite optimal medical therapy. Angioplasty in CTO may lead to complication like coronary perforation which if not managed on time can be catastrophic. However with proper back up, team work and skill such dreaded complication can be taken care of with good outcome.

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“…9) Coronary artery perforation can be classified according to the findings of coronary angiography. Type I perforation is defined as the development of an extraluminal crater without extravasation, type II as a pericardial or myocardial blush without contrast jet extravasation, type III as extravasation through frank (>1 mm) perforation, and cavity spilling as perforation into an anatomic cavity chamber.…”

Section: )2)mentioning

confidence: 99%

A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

Han

Choi

Sohn

et al. 2008

J Cardiovasc Ultrasound

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I In nt tr ro od du uc ct ti io on nCoronary artery perforation is a rare complication during or after percutaneous coronary intervention (PCI) and presents variably from hemodynamically stable concealed hemorrhage to potentially life-threatening cardiac tamponade. Here, we report a patient with coronary artery hematoma associated with coronary artery perforation after failed PCI for chronic total occlusion of right coronary artery, detected on transthoracic echocardiography (TTE). C Ca as se eA 69-year-old man was admitted to our institute with recently aggravated chest pain. He had history of diabetes mellitus. He felt exertional chest pain 6 years ago and was evaluated with coronary angiography which revealed chronic total occlusion of right coronary artery. Medical treatment was initiated and his symptom disappeared thereafter. But, recently he began to have recurrent episodes of exertional chest pain. Exercise stress test was performed and ST segment depression was noted in leads II, III, aVF and V3-6 with typical chest pain. In coronary angiogram, there was 90% stenosis of proximal left anterior descending artery and PCI with stenting was performed.On physical examination, there were no significant findings. Laboratory studies showed no significant abnormalities. The electrocardiogram revealed signs of left atrial enlargement and first degree atrioventricular block with sinus bradycardia. The thoracic roentgenogram showed borderline cardiomegaly. In coronary angiogram, proximal part of the right coronary artery was totally occluded and had collateral flow from left anterior descending artery and left circumflex branch. To perform PCI to stenotic lesion of proximal right coronary artery, we inserted guidewire to proximal right coronary artery but guidewire did not pass through proximal right coronary artery. So we inserted the guidewire to distal right coronary artery using retrograde approach via septal branch of left anterior descending artery. Balloon dilatation underwent using 2.0 mm 15 mm balloon but PCI was failed because the balloon could not pass through the lesion in the mid right coronary artery.Final coronary angiogram showed no extravasation of contrast (Fig. 1). TTE was performed after PCI. The size, shape and function of left ventricle were normal. However, at the right atrioventricular groove, 3.4 cm 2.6 cm-sized prominent epicardial tissue with high echogenecity was noted. The echogenecity of the lesion was higher than that of the pericardial fat, so we interpreted this lesion as a localized A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of m...

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Management and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention

Cited by 155 publications

References 13 publications

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Dangerous Complication of Percutaneous Coronary Intervension (PCI) of Coronary Complete Total Occlusion (CTO) Managed by Complete Total Occlusion (CTO)

A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

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