Coronary bypass graft perforation during percutaneous intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass grafts (CABGs) are susceptible to atherosclerosis, leading to graft stenosis.
• Percutaneous coronary intervention (PCI) in CABGs carries risks like no-reflow, distal embolization, restenosis, thrombosis, and rarely, graft perforation.
• Limited data exists on predictors and management of graft perforation during PCI.

Purpose of the Study:

• To review and analyze reported cases of coronary artery bypass graft perforation during PCI.
• To identify predictors of graft perforation.
• To evaluate management strategies and outcomes for graft perforation.

Main Methods:

• A comprehensive literature review of PubMed/Medline was conducted.
• Data on graft perforations from 1987 to 2015 were collected and analyzed.
• Case characteristics, procedural details, and outcomes were extracted.

Main Results:

• 37 cases of graft perforation were identified.
• High-risk grafts were old (14±7.8 years) with >80% stenosis.
• Perforations occurred during stent placement (30%), balloon angioplasty (36%), and other interventions.
• Class III perforations were common (78%).
• Covered stent implantation (81% of cases) was superior to prolonged balloon inflation for controlling bleeding (p=0.0001).
• 95% of patients had good outcomes, with a prolonged hospitalization (8±4 days).
• Cardiac tamponade occurred in 24% of cases, with 2 peri-procedural deaths.

Conclusions:

• Covered stent grafts are an effective treatment for coronary artery bypass graft perforation.
• This approach yields good immediate and short-term results.
• Management with covered stents is associated with acceptable peri-procedural risks.