Related Experiment Video
Updated: Jun 5, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation
Rasha Al-Lamee1, Alfonso Ielasi, Azeem Latib
1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Insights
Grade III coronary perforation during percutaneous coronary intervention is a rare complication linked to complex lesions. This condition carries high rates of acute and long-term major adverse cardiac events, necessitating prompt management.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Complications
Background:
- Grade III coronary perforation is a rare but serious complication of percutaneous coronary intervention (PCI).
- This complication is associated with significant morbidity and mortality.
Purpose of the Study:
- To evaluate the incidence, predictors, management strategies, and clinical outcomes of grade III coronary perforation during PCI.
- To analyze the effectiveness of various treatment modalities for this complication.
Main Methods:
- Retrospective analysis of 56 patients with grade III coronary perforation from 24,465 PCI procedures (May 1993-December 2009).
- Detailed review of lesion characteristics, causative devices, immediate treatments, and procedural/in-hospital outcomes.
- Assessment of long-term clinical follow-up including major adverse cardiac events (MACE).
Main Results:
- Most perforations occurred in complex lesions (B2/C, chronic total occlusions, small vessels).
- Effective treatments included prolonged balloon inflation (54.5% success), covered stent implantation (84.6% success), and CABG/surgical repair (44.4% success).
- High rates of procedural/in-hospital MACE (55.4%) and mortality (3.6% procedural, 14.8% in-hospital) were observed.
Conclusions:
- Grade III coronary perforation is frequently associated with complex coronary lesions.
- The complication leads to substantial acute and long-term major adverse cardiac event rates.
- Effective management requires a multi-modal approach with varying success rates.
Objectives:
The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention.
Background:
Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality.
Methods:
From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation.
Results:
Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤ 2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%.
Conclusions:
Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates.
Related Concept Videos
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:17Pericarditis III: Medical Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:18Endocarditis III: Medical Management
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:27Coronary Artery Disease V: Interprofessional Care