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Coronary endarterectomy and stent removal after iatrogenic perforation

Toshihiro Fukui1, Shuichiro Takanashi, Wahei Mihara

  • 1Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan. tm-fukui@gem.hi-ho.ne.jp

The Annals of Thoracic Surgery
|February 5, 2004
PubMed

Insights

Coronary perforation is a rare complication of percutaneous coronary intervention (PCI). Surgical removal of a stent and endarterectomy successfully treated a complex case of left anterior descending artery perforation.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
  • Coronary artery perforation is a rare but serious complication of PCI, potentially leading to cardiac tamponade and hemodynamic instability.
  • Type 3 coronary artery perforation, characterized by significant extravasation, presents a significant management challenge.

Observation:

  • A case of type 3 coronary artery perforation occurred after stenting of the left anterior descending artery.
  • The perforation resulted in cardiac tamponade, necessitating pericardiocentesis.
  • Prolonged balloon inflation was ineffective in controlling the hemorrhage.

Findings:

  • Urgent surgical intervention was performed, involving coronary endarterectomy and complete stent removal.
  • A bypass graft using the left internal mammary artery to the left anterior descending artery was successfully created.
  • The surgical approach effectively managed the coronary perforation and its complications.

Implications:

  • Complete stent removal combined with endarterectomy is a viable treatment option for complex coronary artery perforations following stenting.
  • This case highlights the importance of considering surgical intervention for refractory coronary perforations.
  • Successful surgical management can prevent further complications and improve patient outcomes in rare PCI-related emergencies.

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