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Hope for the best, prepare for the worst: How to manage coronary perforations

Bimmer E Claessen1, Roxana Mehran1

  • 1Department of Cardiology, Mount Sinai Hospital, New York, New York.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 13, 2019
PubMed

Insights

Coronary perforation occurs in 0.51% of percutaneous coronary intervention (PCI) procedures, often affecting large vessels. Avoiding oversized devices may reduce perforation incidence, though management guidelines are still needed.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Coronary perforation is a rare but serious complication during percutaneous coronary intervention (PCI).
  • This study analyzes the incidence, characteristics, and outcomes of coronary perforations in a large contemporary PCI cohort.

Discussion:

  • The incidence of coronary perforation was 0.51% in 13,339 PCI procedures, with 75% involving large vessels.
  • Despite a low rate of emergency surgery, in-hospital mortality was notably high at 10%.

Key Insights:

  • Lack of uniform management recommendations for coronary perforations due to their infrequent occurrence.
  • Findings suggest that the use of oversized balloons or stents may be a modifiable risk factor for reducing perforation incidence.

Outlook:

  • Further research is needed to establish standardized management protocols for coronary perforations.
  • Prospective studies focusing on device sizing and procedural techniques could help mitigate this complication.

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