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Thrombin injection for sealing epicardial collateral perforation during chronic total occlusion percutaneous coronary

Anna P Kotsia1, Emmanouil S Brilakis, Dimitri Karmpaliotis

  • 1Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@gmail.com.

The Journal of Invasive Cardiology
|September 9, 2014
PubMed

Insights

Epicardial collateral perforation during retrograde chronic total occlusion percutaneous coronary intervention is a serious risk. Local thrombin injection offers a successful sealing method for this complication.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI) is an advanced technique.
  • Epicardial collateral perforation is a rare but severe complication during CTO-PCI.
  • Management strategies for collateral perforation are limited.

Observation:

  • Two cases of epicardial collateral perforation during retrograde CTO-PCI were encountered.
  • The perforations involved major epicardial collateral arteries.
  • Standard closure techniques were not employed.

Findings:

  • Local thrombin injection was successfully used to seal the epicardial collateral perforations.
  • Hemostasis was achieved in both cases without further complications.
  • This represents a novel approach to managing collateral vessel injury.

Implications:

  • Local thrombin injection may be a safe and effective treatment for epicardial collateral perforation.
  • This technique could potentially reduce the morbidity associated with CTO-PCI complications.
  • Further research is warranted to validate this approach in a larger cohort.

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