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Coronary artery perforations in the contemporary interventional era
T J Kiernan1, B P Yan, N Ruggiero
1Division of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Insights
Coronary artery perforation is a rare but serious complication of percutaneous coronary intervention (PCI), occurring in 0.48% of cases. Wire manipulation is the most common cause, highlighting the need for careful technique during PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Complications
Background:
- Coronary perforations are a significant, albeit rare, complication during percutaneous coronary intervention (PCI).
- Understanding the incidence, causes, and management of these events is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the incidence, causes, and management strategies for coronary artery perforations.
- To identify the primary drivers of coronary perforations in the context of modern PCI.
Main Methods:
- Retrospective analysis of coronary perforations at Massachusetts General Hospital from 2000 to 2008.
- Involved a review of medical records and detailed angiographic analysis of 68 identified cases.
Main Results:
- An overall incidence of 0.48% for coronary perforations was observed in 14,281 PCIs.
- Wire manipulation, particularly with hydrophilic wires, was the leading cause (66.2%).
- Management included angioplasty balloons (23.5%) and stents (20.6%), with a 5.9% in-hospital mortality rate.
Conclusions:
- Coronary artery perforation remains a rare complication of PCI, with an incidence of 0.48% in this series.
- Wire injury is the predominant cause of coronary perforations in the current PCI era.
Background:
Coronary perforations represent a serious complication of percutaneous coronary intervention (PCI).
Methods:
We performed a retrospective analysis of documented coronary perforations at Massachusetts General Hospital from 2000 to 2008. Medical records review and detailed angiographic analysis were performed in all patients.
Results:
Sixty-eight cases of coronary perforation were identified from a total of 14,281 PCIs from March 2000 to March 2008 representing an overall incidence of 0.48%. The study cohort was predominantly male (61.8%), mean age 71+/-11 years with 78% representing acute cases (unstable angina: 36.8%, NSTEMI: 30.9%, STEMI: 10.3%). Coronary artery perforation occurred as a complication of wire manipulation in 45 patients (66.2%) with 88.9% of this group being hydrophilic wires, of coronary stenting in 11 (16.2%), of angioplasty alone in 6 (8.8%), and of rotational atherectomy in 8 (11.8%). The perforation was sealed with an angioplasty balloon alone in 16 patients (23.5%), and with stents in 14 patients (20.6%) (covered stents: 11.8% and noncovered stents: 8.8%). Emergency CABG was performed in 2 patients (2.9%). Five patients (7.4%) developed periprocedural MI. The in-hospital mortality rate was 5.9% in the study cohort.
Conclusion:
Coronary artery perforation as a complication of PCI is still rare as demonstrated in our series with an incidence of 0.48%. The predominant cause of coronary perforations in the current era of PCI is wire injury.
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