Rare vascular perforation complicating radial approach to percutaneous coronary angioplasty

Farooqi, Fahad; Alexander, John; Sarma, Aditya

doi:10.1136/bcr-2012-007732

Cited by 17 publications

(16 citation statements)

References 5 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our case of inferior thyroid arterial bleeding, which resulted in a mediastinal hemorrhage complicating tracheal compression and respiratory failure during transradial PCI, was successfully treated with endovascular embolization and mediastinotomy drainage. To our knowledge, this is the third case report of inferior thyroidal arterial bleeding (including thyrocervical truck) during transradial PCI, [ 11 , 12 ] the twelfth report of mediastinal hemorrhage or hematoma, [ 3 – 6 , 8 – 14 ] and the fifth description of tracheal compression requiring endotracheal intubation [ 4 , 10 – 12 ] Moreover, it is the first case report of inferior thyroid bleeding during transradial PCI using an angled J-type hydrophilic wire, and succeeding in bleeding control using a microcoil, gel sponge, and glue.…”

Section: Discussionmentioning

confidence: 99%

“…Once the bleeding focus is confirmed on chest CT, the peripheral angiography should be performed immediately. Although a few cases initially achieved successful treatment with conservative therapy alone, [ 3 , 8 , 10 , 12 , 13 ] most cases reported progressive bleeding and deteriorated patient status, which led to the emergency peripheral intervention. Therefore, both prompt peripheral angiography and endovascular intervention are recommended.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] This evidence supports a “radial-first” strategy in various current guidelines, including ST-segment elevation myocardial infarction (STEMI). [ 2 ] Despite an extremely low incidence of complications, often trivialized in the literature, [ 3 ] the transradial approach is not free of life-threating vascular complications, particularly brachiocephalic artery perforation, [ 3 , 4 ] subclavian vessel dissection, [ 3 , 5 – 9 ] and vessel perforation in the internal mammary artery, [ 1 ] costocervical trunk, [ 10 ] and thyrocervical trunk. [ 11 , 12 ] Thus, the intervention cardiologist must be well-informed about the life-threating complications specific to the radial approach and have countermeasures implemented in advance.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fatal vascular complications during transradial percutaneous coronary intervention

Choi¹,

Joh²,

Choe

2020

Medicine

View full text Add to dashboard Cite

Rationale: Vascular complications of transradial percutaneous coronary intervention (PCI) are rare and usually occur at the access site below the elbow. However, vessels along the tract of the wire or catheter can be injured at any point, causing various types of bleeding complications. Patient concerns: A 57-year-old man visited due to chest discomfort. Coronary angiography showed significant stenosis at the distal right coronary artery (RCA). Immediately after the coronary guidewire was passed through the distal RCA, he started a vigorous cough. The voice changed, dyspnea occurred within minutes, and lip cyanosis and stridor were observed. After endotracheal intubation, successful stenting of the distal RCA was achieved. He was extubated at 30 minutes after coronary stenting, but 1-hour post-extubation, his blood pressure suddenly decreased to 70/50 mmHg. Diagnosis: Mediastinal widening was newly noted on chest X-ray, and blood hemoglobin was decreased. Contrast-enhanced chest computed tomography showed mediastinal hematoma, tracheal compression, and hemothorax. Contrast extravasation was noted in the terminal branches of the inferior thyroid artery on brachiocephalic angiography. Interventions: Successful hemostasis was achieved with endovascular embolization therapy using a Tornado embolization microcoil, Gelfoam gelatin sponge, and Histoacryl glue. The next day, the mediastinal hemorrhage was drained by mediastinoscopy. The endotracheal intubation and ventilator care were maintained for 2 days, and 6 units of packed red blood cells were transfused. Antithrombotics were used to prevent stent thrombosis, and antibiotics to control infection, respectively. Outcomes: After successful hemostasis, thrombocytosis and high on-treatment platelet reactivity that disappeared at 2 weeks post-discharge were noted. Follow-up chest imaging showed the normalized mediastinal widening. At 14 months post-discharge, the patient remains healthy. Lessons: As life-threating vascular complications, such as brachiocephalic, subclavian vessel dissection, and vessel perforation in the internal mammary, costocervical, and thyrocervical arteries, can occur anytime during transradial PCI, the intervention cardiologist should be well aware of it and have the appropriate countermeasures implemented in the routine procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fatal vascular complications during transradial percutaneous coronary intervention

Choi¹,

Joh²,

Choe

2020

Medicine

View full text Add to dashboard Cite

show abstract

“…Farooqi et al . [14] described an exemplary guidewire-induced perforation of the costocervical trunk, which presented only after a coronary intervention. The complication remained unnoticed until a rapidly expanding cervical haematoma caused airway compromise leading to intubation and interventional therapy.…”

Section: Discussionmentioning

confidence: 99%

Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions

Pasecki¹,

Narloch²,

Tkaczewski³

et al. 2018

Pol J Radiol

View full text Add to dashboard Cite

PurposeInterventional cardiology and interventional radiology are separate medical disciplines in which intra-arterial contrast media are used. Interventional cardiology has resigned from many types of treatment techniques that are now used and developed in the field of interventional radiology. In the event of iatrogenic bleeding during coronary interventions, there is an urgent need to use safe and efficient rescue procedures that are as efficient as cardiosurgery but use simpler treatment options. Serious perforations require immediate endovascular interventions. Medical history may reveal risk factors for artery perforation. Medicines, location of artery perforation, and extent of bleeding are directly associated with the prognosis. Most often, arterial perforations are due to inappropriate wire manipulation or use of oversized balloons or cutting balloons. Prolonged, artery-occluding balloon inflation, covered stent implantation, and embolisation with different agents are among the available treatment options for artery ruptures.Material and methodsA retrospective analysis was carried out among selected patients with iatrogenic vascular complications during procedures involving either coronary or non-coronary arteries.ResultsOnly representative cases were selected and presented in the patient subsection.ConclusionsArtery perforation during cardiac catheterisation can lead to dire consequences. To manage this complication, clinicians need pre-established procedures, adequate resources, and knowledge. Interventional radiology can be used as a salvage therapy in such cases.

show abstract

“…Perforation of the TT is one of the less frequent iatrogenic central artery perforation events reported in the literature, yet management is analogous to iatrogenic costocervical perforation during transradial percutaneous coronary intervention [ 15 ]. Case management begins with the identification of the TT perforation and accompanying pseudoaneurysm using subselection angiography of the TT [ 14 ].…”

Section: Reviewmentioning

confidence: 99%

Iatrogenic Arterial Perforation During Endovascular Interventions

Rizk

Patel

Dimitri

et al. 2020

Cureus

View full text Add to dashboard Cite

The use of minimally invasive endovascular procedures has increased, and as such, the frequency of associated vascular complications has also increased. Regardless of the access site location, rarely, arterial perforation can occur, which can be fatal if not properly managed. Interventionalists should be aware of the risk factors for perforation, commonly perforated vessels, and how different sites of perforation are diagnosed and managed. Rapid recognition and endovascular management reduce the need for open surgical repair, and thus reduce the morbidity and mortality of these complications. This review outlines the presentation, diagnosis, and management of iatrogenic perforations of the subclavian artery, thyrocervical trunk (TT), common carotid artery, superficial femoral artery (SFA), and external iliac artery.

show abstract

Rare vascular perforation complicating radial approach to percutaneous coronary angioplasty

Cited by 17 publications

References 5 publications

Fatal vascular complications during transradial percutaneous coronary intervention

Fatal vascular complications during transradial percutaneous coronary intervention

Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions

Iatrogenic Arterial Perforation During Endovascular Interventions

Contact Info

Product

Resources

About