AI Article Synopsis
- Coronary perforation (CP) is a rare but potentially life-threatening complication that can occur during percutaneous coronary intervention (PCI), with a low incidence of 0.86% in the study's 3469 cases.
- The study identified 30 cases of CP, classifying them into three grades: type I (56%), type II (7%), and type III (37%), with stents being the leading cause of type III perforations.
- Management for type III CP often necessitated urgent bypass surgery in 36% of patients, and while prolonged balloon inflation was effective, it required significantly more time for stent-related CP compared to other causes.
Article Abstract
Background: Coronary perforation (CP) is a rare, sometimes lethal complication of percutaneous coronary intervention (PCI).
Objectives: The purpose of this study was to review the cases of CP and to investigate the management after CP.
Methods: A total of 3469 PCIs were performed in our institution from April 1999 to April 2008. All CP cases were identified from our computerized database.
Results: Thirty patients were identified as having CP (0.86%). According to the Ellis classification, we determined the grade of perforation as type I in 17 cases (56%), type II in 2 cases (7%), and type III in 11 cases (37%). Most CPs were caused by wires (53%), while balloons, stents, and atherectomy devices were responsible for 7%, 37%, and 3%, respectively. Wire caused only 1 case of type III CP (6%), while stent caused 9 type III CPs (82%, p<0.01). Four patients (36%) with type III CP required urgent coronary artery bypass graft surgery (CABG), while no patient with type I/II CP required it (p<0.01). Prolonged balloon inflations were effective for 8 cases out of 11 stent CPs, however, the ballooning duration was significantly longer than that in wire and balloon CP (44±37min vs. 21±13min, p<0.05).
Conclusions: Stent CP often causes type III CP and one third of type III CP required urgent CABG. Although stent CP required longer balloon inflations for the management, prolonged balloon inflation might be useful for the management even in the stent CP.
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| http://dx.doi.org/10.1016/j.jjcc.2012.11.007 | DOI Listing |
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