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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

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

Published on: March 15, 2022

Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary

Avi Shimony1, Doron Zahger, Michael Van Straten

  • 1Department of Cardiology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel. ashimony@bgu.ac.il

The American Journal of Cardiology
|December 8, 2009
PubMed

Insights

Coronary artery perforation (CP), a rare complication of percutaneous coronary intervention, occurred in 0.59% of cases. Treating chronic total occlusions was the strongest predictor of CP.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Coronary artery perforation (CP) is a rare but potentially lethal complication of percutaneous coronary intervention (PCI).
  • Limited contemporary data exist on CP's predictors, incidence, and outcomes in the current PCI era.

Purpose of the Study:

  • To determine the incidence, associated factors, and outcomes of CP.
  • To compare patients with CP to a control group undergoing PCI without CP.

Main Methods:

  • Retrospective analysis of CP cases during PCI from January 2001 to December 2008 at a tertiary center.
  • Comparison of 57 CP patients with 171 controls, collecting demographic, clinical, and procedural data.
  • Classification of perforations using the Ellis classification.

Main Results:

  • CP incidence was 0.59% (57/9,568 interventions).
  • Vessel perforation causes included wires (52.6%), balloons (26.3%), and stents (21.1%).
  • CP was associated with 7% mortality and 16% tamponade rates, primarily with Grade III perforations. Treating chronic total occlusions, coronary calcification, and non-ST elevation myocardial infarction were independent predictors of CP.

Conclusions:

  • CP is rare but associated with significant mortality and tamponade, particularly Grade III perforations.
  • Most Grade I and II perforations can be managed conservatively.
  • Percutaneous coronary intervention for chronic total occlusions presents the highest risk for CP.

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