Stent Graft Used to Rescue Coronary Rupture during Percutaneous Coronary Intervention for Myocardial Bridge

Shen, Thau-Yun; Chen, Chien‐Cheng; Tseng, Yung‐Zu

doi:10.2169/internalmedicine.48.1953

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Myocardial bridging is asymptomatic in most of the cases, but in rare instances it may be associated with serious complications such as acute coronary syndromes, lethal arrhythmias, and even sudden death. Symptomatic patients with objective evidence of ischemia on noninvasive stress tests and which are refractory to medical therapy, PCI, or surgical treatment should be preferred [17]. Our case may be interesting due to the nature of the target lesion (a bridging segment), and to the best of our knowledge such cases were not described constantly.…”

Section: Discussionmentioning

confidence: 98%

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Ekici

Erkan

Kütük

et al. 2014

Case Reports in Medicine

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Perforation of coronary arteries is a relatively rare yet life-threatening complication of percutaneus coronary interventions and is encountered in approximately 0.5% of these procedures. According to the type of coronary perforation, various methods of correction are employed, ranging from conservative approach to emergency cardiac surgery. Coronary stent-grafts are composed of two metal stents and a polytetrafluoroethylene layer between them. Advent of such stents enabled efficient endovascular repair of coronary artery perforation. We present a case of coronary artery perforation which had occurred during stent implantation for the treatment of a bridged segment in the distal portion of the left anterior descending artery. This perforation was successfully managed by implanting a stent-graft.

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Section: Discussionmentioning

confidence: 98%

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Ekici

Erkan

Kütük

et al. 2014

Case Reports in Medicine

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“…20 Shen et al presented a case of coronary perforation during PCI for muscle bridge segment, successfully managed with implanting covered stent. 21 …”

Section: Discussionmentioning

confidence: 99%

Increased risk of coronary perforation during percutaneous intervention of myocardial bridge: What histopathology says

Pourhoseini¹,

Bakhtiari²,

Babaee³

et al. 2017

J Cardiovasc Thorac Res

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Introduction: Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention. Methods: Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery. Results: The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal. Conclusion: The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.

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“…The Graftmaster stent graft is indicated in repair of coronary artery perforation and is contraindicated in cases where treatment area is limited to allow full balloon dilation or placement of the stent graft. Previous cases have reported perforation of the bridged segment of coronary artery into the right ventricle and the pericardial space (Table 1 [ 2,3,[13][14][15][16][17][18][19][20]). We here report the first case of perforation of a tunneled coronary artery into the left ventricle.…”

Section: Ali Et Al J Med Cases 2017;8(3):77-80mentioning

confidence: 99%

“…This bridge compresses the tunneled segment during systole, which remains clinically silent in most cases [2,3]. Although usually asymptomatic in the majority of patients, symptomatic patients often require treatment [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

2017

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A myocardial bridge (MB) is a band of heart muscle that lies on the top of a coronary artery, instead of underneath it. This leads to tunneling of coronary artery through this segment of the myocardium which can be mechanically compressed during systole, also known as myocardial bridging. Although usually asymptomatic, it can be associated with exertional angina, acute coronary syndrome, cardiac arrhythmia or even sudden cardiac death. The utilization of percutaneous coronary intervention (PCI) of the bridged segment to ameliorate vessel compression and normalize blood flow is limited due to concerns of complications, particularly restenosis and perforation. Although conventional management of coronary perforation includes prolonged balloon dilation and reversal of anticoagulation, stent grafting of these perforations is not uncommonly utilized. We report a case of a patient with symptomatic MB who underwent a PCI of the bridging segment of the left anterior descending (LAD) coronary arterywhich was complicated with a perforation into the left ventricle. As patient became symptomatic, the perforation was emergently repaired using a Graftmaster ® RX coronary stent graft system (Abbott Vascular) with complete alleviation of symptoms and successful radiographic resolution.

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Stent Graft Used to Rescue Coronary Rupture during Percutaneous Coronary Intervention for Myocardial Bridge

Abstract: Myocardial bridge (MB) is a congenital variation of the coronary arteries and the segment of the coronary

Cited by 5 publications

References 12 publications

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Increased risk of coronary perforation during percutaneous intervention of myocardial bridge: What histopathology says

Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

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