Coronary artery perforation complicating percutaneous coronary intervention
Aram J Mirza1, Abdulsalam Y Taha2, Jaafar S Aldoori1
11 Department of Cardiology, Slemani Cardiac Hospital, Sulaimaniyah, Region of Kurdistan, Iraq.
Insights
Coronary artery perforation, a rare percutaneous coronary intervention complication, was effectively managed in Iraq. Early treatment with covered stents and balloon inflations led to successful outcomes without surgery or death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Complications
Background:
- Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions (PCI).
- Evaluating the management strategies for coronary artery perforation is crucial for improving patient outcomes.
- This study focuses on the experience in Sulaimaniyah, Iraq, from 2009 to 2016.
Purpose of the Study:
- To evaluate the management of coronary artery perforation (CAP) in patients undergoing percutaneous coronary interventions.
- To analyze the causes, types, and treatment outcomes of coronary artery perforation.
- To assess the effectiveness of different management strategies, including covered stents and balloon inflations.
Main Methods:
- Retrospective review of medical records of 24 patients diagnosed with coronary artery perforation between 2009 and 2016.
- Diagnosis based on clinical presentation (worsening symptoms, hypotension) and angiographic evidence (Types I, II, III perforation).
- Management involved heparin reversal, cessation of antiplatelets, aspiration of pericardial effusions, and sealing perforations with covered stents or balloon inflations.
Main Results:
- The left anterior descending artery was the most frequently injured artery (58.3%).
- Type II and III perforations were most common (75%), often associated with severe coronary stenosis (54.2%).
- Covered stents were used in 15 cases, balloon inflations in 2, and 7 resolved spontaneously. No deaths or surgical interventions were required.
Conclusions:
- Coronary artery perforation can be managed effectively with a low complication rate and no mortality.
- Early diagnosis and prompt intervention, particularly using covered stents, are key to successful management.
- This study highlights successful outcomes in managing coronary artery perforations in a specific Iraqi setting.
Abstract:
Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.
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