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. 2002 Nov;88(5):495-8.
doi: 10.1136/heart.88.5.495.

Coronary artery perforation during percutaneous intervention: incidence and outcome

M G Gunning  1 , I L Williams, D E Jewitt, A M Shah, R J Wainwright, M R Thomas
Affiliations

Coronary artery perforation during percutaneous intervention: incidence and outcome

M G Gunning et al. Heart. 2002 Nov.

Abstract

Objective: To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation.

Setting: Tertiary referral centre.

Methods: The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%).

Results: In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent.

Conclusions: Coronary artery perforation with sequelae during intervention is rare--26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not risk-free procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.

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Figures

Figure 1
Figure 1
Clinical management of patients with coronary vessel perforation following percutaneous intervention.
Figure 2
Figure 2
Number of patients where coronary vessel perforation resulted in haemodynamically significant pericardial effusion per year.
See this image and copyright information in PMC

References

    1. Gruberg L, Pinnow E, Flood R, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2000;86:680–2. - PubMed
    1. Von Sohsten R, Kopistansky C, Cohen M, et al. Cardiac tamponade in the new device era: evaluation of 6999 consecutive percutaneous coronary interventions. Am Heart J 2000;140:279–83. - PubMed
    1. Kimbris D, Iskandrian AS, Goel I, et al. Transluminal coronary angioplasty complicated by coronary artery perforation. Cathet Cardiovasc Diagn 1982;8:481–7. - PubMed
    1. Grollier G, Bories H, Commeau P, et al. Coronary artery perforation during coronary angioplasty. Clin Cardiol 1986;9:27–9. - PubMed
    1. Topaz O, Cowley MJ, Vetrovec GW. Coronary artery perforation during angioplasty; angiographic detection and demonstration of complete healing. Cathet Cardiovasc Diagn 1992;27:284–8. - PubMed

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