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Surgical treatment for Ellis type 3 coronary perforation during percutaneous catheter intervention

Toshinori Totsugawa1, Masahiko Kuinose, Hidenori Yoshitaka

  • 1Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan. toshinoritotsugawa@gmail.com

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 2, 2011
PubMed

Insights

Coronary perforation (CP) from balloon inflation during percutaneous coronary intervention (PCI) often leads to severe complications. Prompt surgical repair is crucial, especially if re-bleeding occurs after covered stent placement.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Coronary perforation (CP) is a rare but potentially fatal complication during percutaneous catheter intervention (PCI).
  • This study focuses on surgically-treated cases of type 3 CP.

Purpose of the Study:

  • To analyze surgically-treated cases of type 3 coronary perforation during PCI.
  • To compare outcomes of CP caused by balloon inflation versus rotational atherectomy.

Main Methods:

  • Review of 5 patients who underwent surgical repair for type 3 CP between 2007 and 2010.
  • Analysis of patient demographics, lesion characteristics (SYNTAX score, artery location), perforation cause, and in-hospital outcomes.

Main Results:

  • The 5 patients (3 male, 2 female) had a mean age of 74 years, with a mean of 2.6 diseased coronary branches and a mean SYNTAX score of 45.
  • Left anterior descending artery was the target in 4 cases, right coronary artery in 1. Most lesions were complex (type B2/C).
  • Balloon inflation caused perforation in 4 patients, rotational atherectomy in 1. In-hospital mortality was 20%. Severe lacerations from balloon inflation led to re-bleeding requiring cardiopulmonary support and emergency surgery.

Conclusions:

  • Balloon-induced CP often results in more severe conditions than rotablator-induced CP.
  • Immediate surgical intervention is recommended for balloon-induced type 3 CP, even after initial hemostasis with covered stents, if re-bleeding is a risk.
Abstract

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