Successful treatment of coronary artery perforation during angioplasty using autologous vein graft-coated stent

Chae, Jang Seong; Park, S.-W.; Kim, Y.-H.; Hong, Myeong‐Ki

doi:10.1093/oxfordjournals.eurheartj.a015362

Cited by 32 publications

(18 citation statements)

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“…Recently, catastrophic perforations in native vessels and saphenous vein grafts have also been managed successfully with autologous vein cover stents [25][26][27][28][29][30] or using stents with a PFTE coating, 31,32 and this approach was used successfully in 1 patient in the pesent series. While covered stents are useful in sealing a ruptured coronary vessel, they must be used with caution in regions of significant side branching and they do not appear to reduce restenosis.…”

Section: Management Of Coronary Perforationmentioning

confidence: 99%

Early and Late Clinical Outcomes Following Coronary Perforation in Patients Undergoing Percutaneous Coronary Intervention.

Fukutomi

Suzuki

Popma

et al. 2002

Circ J

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hile coronary perforation is an uncommon complication following percutaneous coronary intervention (PCI), [1][2][3][4][5][6][7][8] it is one that may lead to cardiac tamponade, 6-9 emergency coronary artery bypass surgery (CABG), or pseudoaneurysm formation, 10 with the potential for late coronary rupture. New coronary devices that resect (eg, directional or transluminal extraction atherectomy), ablate (eg, rotational atherectomy or excimer laser angioplasty), or score (eg, the cutting balloon) atherosclerotic plaque may increase the risk of coronary perforation, and a number of angiographic risk factors for its occurrence have been described previously. [11][12][13][14] The use of newer higher-weight and hydrophilic coronary guidewires may also increase the risk of coronary perforation, particularly during the treatment of chronic coronary occlusions. Clinical algorithms for the treatment of coronary perforation based on angiographic and clinical criteria have been Circulation Journal Vol.66, April 2002 less well studied. Moreover, descriptions of the long-term sequelae after coronary perforation, and delineation of the potential risk for late pseudoaneurysm formation and coronary rupture, have been lacking.The present study examines the frequency of coronary perforation during PCI, evaluates the management strategies used to treat the perforation, and describes the long-term prognosis in patients who have developed coronary perforation during PCI. To address these issues, we reviewed our experience with coronary perforation in a consecutive series of 7,443 patients undergoing PCI at a single, highvolume clinical center. Methods Patient PopulationBetween January 1992 and December 1996, 7,443 coronary interventional procedures were performed in the Cardiac Catheterization Laboratory at National Toyohashi Higashi Hospital. These procedures included conventional balloon angioplasty (n=4,895; 65.8%), cutting balloon angioplasty (n=1,274; 17.1%), coronary artery stenting (n=810; 10.9%), directional coronary atherectomy (DCA) (n=440; 5.9%), and transluminal extraction catheter atherectomy (n=24, 0.32%). Coronary perforation is a rare but serious complication that occurs during percutaneous coronary intervention (PCI). This study examines the frequency of coronary perforation during PCI, evaluates the management strategies used to treat perforations, and describes the long-term prognosis of patients who have developed coronary perforation during PCI. Coronary perforations were found in 69 (0.93%) of 7,443 consecutive PCI procedures, occurring more often after use of a new device (0.86%) than after use of balloon angioplasty (0.41%) (p<0.05).Coronary perforation was attributable solely to the coronary guidewire in 27 (0.36%) cases. Coronary perforations were divided into 2 types: (1) Those with epicardial staining without a jet of contrast extravasation (type I, n=51), and (2) those with a jet of contrast extravasation (type II, n=18). Patients with type I and type II perforations were managed by observation only (3...

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Section: Management Of Coronary Perforationmentioning

confidence: 99%

Early and Late Clinical Outcomes Following Coronary Perforation in Patients Undergoing Percutaneous Coronary Intervention.

Fukutomi

Suzuki

Popma

et al. 2002

Circ J

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“…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]. Additionally, lifesaving measures intended at occlusion of the distal vessel by coils, gelfoam, precoagulated autologous blood and intracoronary thrombin have been used [9].…”

Section: /5mentioning

confidence: 83%

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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“…Literature reports on the implantation of stent grafts in coronary vessels include de novo stenoses [10,11], bailout situation [10], coronary rupture and perforation [12,13], as well as thrombotic coronary lesions in acute myocardial infarction [14]. Here, autologous veins [12][13][14] and in one case a piece of the radial artery [11] were used as graft material. The surgical removal of the vessel material, however, means an additional encumbrance for the patient and leads to a further lengthening of the whole procedure, with an increased risk of myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Unexpanded, irretrievable stent in the proximal right coronary artery: Successful management with stent graft implantation

Lotze

Ferrari

Dannberg

et al. 1999

Cathet. Cardiovasc. Intervent.

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Stent loss and failure of retrieval are rare; nevertheless, complications have to be taken into account during percutaneous coronary intervention. Here we report a case of an unexpanded, irretrievable Palmaz‐Schatz stent in the proximal right coronary artery near to the ostium and the successful management by implanting a synthetic stent graft. Cathet. Cardiovasc. Intervent. 46:344–349, 1999. © 1999 Wiley‐Liss, Inc.

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Successful treatment of coronary artery perforation during angioplasty using autologous vein graft-coated stent

Cited by 32 publications

References 0 publications

Early and Late Clinical Outcomes Following Coronary Perforation in Patients Undergoing Percutaneous Coronary Intervention.

Early and Late Clinical Outcomes Following Coronary Perforation in Patients Undergoing Percutaneous Coronary Intervention.

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

Unexpanded, irretrievable stent in the proximal right coronary artery: Successful management with stent graft implantation

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