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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

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Coronary perforation during percutaneous coronary intervention.

Akihiro Shirakabe¹, Hitoshi Takano, Shunichi Nakamura

¹First Department of Internal Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.

International Heart Journal

|March 24, 2007

Summary

Coronary perforation during percutaneous coronary intervention (PCI) is rare but serious. Prompt management with protamine and nonsurgical devices can effectively control bleeding and improve outcomes.

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Area of Science:

Cardiology
Interventional Cardiology

Background:

Coronary perforation is a rare but serious complication of percutaneous coronary intervention (PCI).
Understanding the factors contributing to perforation and its outcomes is crucial for improving patient care.

Purpose of the Study:

To review and analyze cases of overt coronary perforation during PCI.
To evaluate the clinical backgrounds, lesion characteristics, management strategies, and outcomes of patients experiencing coronary perforation.

Main Methods:

Retrospective review of 12 cases of coronary perforation from 3415 PCI procedures (1991-2005).
Analysis of perforation causes, management techniques (balloon inflation, covered stent graft, surgical repair), and complications (cardiac tamponade, congestive heart failure).

Main Results:

Coronary perforation occurred in 0.35% of PCI procedures, often during wiring or device use.
Management included balloon inflation (7 cases), covered stent graft (1 case), and surgical repair (1 case).
Complications included cardiac tamponade (3 patients) and one death from heart failure; protamine administration was effective in 6 patients.

Conclusions:

Coronary perforation during PCI, though infrequent, carries significant morbidity and mortality.
Intravenous protamine, combined with nonsurgical devices, is effective for initial management of coronary perforation.
Continued antiplatelet therapy did not lead to rebleeding in this series.