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Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary

Tatsuya Fukutomi1, Takahiko Suzuki, Jeffrey J Popma

  • 1The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Aichi, Japan. tfuku@med.nagoya-cu.ac.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|April 17, 2002
PubMed

Insights

Coronary perforation during percutaneous coronary intervention (PCI) is uncommon (0.93%). Most perforations are managed successfully without surgery, though late pseudoaneurysms can occur, especially with severe perforations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Complications

Background:

  • Coronary perforation is a rare but serious complication during percutaneous coronary intervention (PCI).
  • Understanding its frequency, management, and prognosis is crucial for patient care.

Purpose of the Study:

  • To determine the incidence of coronary perforation during PCI.
  • To evaluate management strategies for coronary perforations.
  • To describe the long-term outcomes of patients experiencing coronary perforation.

Main Methods:

  • Retrospective analysis of 7,443 consecutive PCI procedures.
  • Classification of perforations into Type I (staining) and Type II (extravasation).
  • Evaluation of management strategies including observation, anticoagulation reversal, pericardiocentesis, and prolonged balloon angioplasty.

Main Results:

  • Coronary perforation occurred in 0.93% of PCI procedures, more frequently with new devices than balloon angioplasty.
  • Guidewires were the sole cause in 0.36% of cases.
  • Type II perforations (jet extravasation) were associated with higher rates of pseudoaneurysm formation (72.2%) compared to Type I (11.1%).
  • No in-hospital deaths occurred; most patients were managed without surgery.
  • Late pseudoaneurysms developed in 28.6% of patients during follow-up.

Conclusions:

  • Coronary perforation is an infrequent complication of PCI.
  • Effective management strategies exist, often avoiding the need for cardiac surgery.
  • Close monitoring is necessary due to the risk of late pseudoaneurysm development, particularly in Type II perforations.

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