Utilization and outcomes of transcatheter coil embolization for various coronary artery lesions: Single‐center 12‐year experience

Abstract

Objective Determining the outcomes of transcatheter coil embolization (TCE) for several coronary artery lesions. Background TCE has been used as a treatment modality for various lesions in the coronary circulation. However, data on the efficacy and safety of TCE to treat coronary artery fistula (CAF), left internal mammary artery (LIMA) side‐branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) are limited. Methods We conducted a retrospective, descriptive analysis of all TCE devices in coronary lesions at our center from 2007 to 2019. Forty‐one studied lesions included 25 CAF, 7 LIMA side‐branch, 5 CAP, 2 CAA, and 2 CAPA. Short‐ and 1‐year mortality and hospital readmission were reported, in addition to coil‐related complications and procedural success. Results The utilization rate of TCE in coronary artery lesions at our center was found to be 33.8 per 100,000 percutaneous coronary intervention procedures over 12 years. Successful angiographic closure was achieved in 37 out of 41 (87.8%) cases (88, 100, 60, 100, and 100% of CAF, LIMA side‐branch, CAP, CAA, and CAPA, respectively). No adverse events were directly related to TCE among the LIMA, CAA, and CAPA cases, and only one patient with CAF required reintervention at 3 months due to coil migration. Conclusions Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with a 87.8% overall success rate. Further study on the use of vascular plug devices in cases such as CAF or LIMA side‐branch would be beneficial to understand the treatment options better.

Outcomes of Transcatheter Closure of Congenital Left Circumflex Coronary Artery Fistula

“…3,15, 16 Recently, Abdelfattah et al reported successful angiographic transcatheter coil embolization in 88% of CAF cases. 17 In the present study, tortuous fistulas were observed in 91% (20/22) of LCX-CAF patients. However, coils were used for TCC in only 18.2% (4/22) of cases.…”

Coils embolization use for coronary procedures: Basics, indications, and techniques

“…5,[27][28][29] Unlike main vessel CAP which can be treated with covered stents, distal perforations are often too small to utilize covered stent and are usually treated by embolization using coils or other methods such as fat embolization. 2,5,27,30 There has been a significant increase in CTO PCI and complex procedures that led to an increase in the risk of complications, particularly perforations, and in turn to an increase in the need for coronary coils. The risk of perforation increases further in retrograde CTO PCI as compared to antegrade approach, making it an independent predictor of risk for perforation in CTO procedures.…”

“…Distal perforations typically occur due to wire migration and is commonly associated with the use of hydrophilic, polymer‐jacketed wires, (88.9% of CAP reported as due to hydrophilic wires) 5,27–29 . Unlike main vessel CAP which can be treated with covered stents, distal perforations are often too small to utilize covered stent and are usually treated by embolization using coils or other methods such as fat embolization 2,5,27,30 …”

“…Most publications on coils utilization during percutaneous coronary intervention (PCI) have been either case reports or single center retrospective studies. In a large single center series, coils were used in 0.03% (41 out of 121,196 PCI procedures) 2 . With increasing age and complexity of coronary artery disease, 3–5 the incidence of coronary perforation is likely to increase highlighting the importance of interventional cardiology education on the basics of coils, including design, materials, indications, and mode of delivery.…”

When and how to close vessels in the cardiac catheterization laboratory

“…In this issue of the journal, Abdelfattah et al describe the outcomes of 41 coil embolizations performed over a 12-year period at a tertiary cardiac catheterization laboratory. 1 Coil embolization represented 0.034% of PCIs and was performed for various indications: 25 coronary artery fistulas, 7 left internal mammary artery side branches, 5 coronary artery perforations, 2 coronary artery aneurysms and 2 coronary artery pseudoaneurysms. Successful closure was achieved in 87.8% of cases with only one adverse event directly related to coil embolization due to coil migration requiring re-intervention at 3 months.…”