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Chronic total occlusion percutaneous coronary intervention: managing perforation complications

Francesco Moroni1, Emmanouil S Brilakis2, Lorenzo Azzalini3

  • 1Università Vita-Salute San Raffaele , Milan, Italy.

Expert Review of Cardiovascular Therapy
|November 11, 2020
PubMed

Insights

Coronary artery perforation (CAP) is a rare but serious complication of percutaneous coronary intervention (PCI), especially in chronic total occlusion (CTO) PCI. Prompt management with available devices and training is crucial for optimal outcomes.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Imaging
  • Medical Device Technology

Background:

  • Coronary artery perforation (CAP) is an infrequent complication of percutaneous coronary intervention (PCI), with higher incidence during complex chronic total occlusion (CTO) PCI.
  • CAP can lead to severe consequences such as cardiac tamponade and death.
  • The complexity of CTO lesions and recanalization techniques increases the risk of CAP.

Purpose of the Study:

  • To review features of CTO PCI predisposing to CAP.
  • To describe procedural scenarios where CAP may occur.
  • To present a universal management algorithm and treatment options for CAP.

Main Methods:

  • Expert review of current literature and clinical practices.
  • Discussion of predisposing factors and procedural scenarios for CAP in CTO PCI.
  • Detailed presentation of CAP treatment devices, techniques, and imaging support.

Main Results:

  • CAP incidence is higher in CTO PCI due to lesion complexity and advanced techniques.
  • A universal management algorithm for CAP is proposed.
  • Available devices and techniques for CAP treatment, including imaging and medical/surgical management, are discussed.

Conclusions:

  • The incidence of CAP is expected to rise with increasing CTO PCI volumes and complexity.
  • Adherence to best practices, availability of specialized equipment, and adequate training are essential for CAP prevention and management.
  • Effective management strategies involve sealing CAP, pericardiocentesis, hemodynamic support, and comprehensive training.
Abstract

Keywords:
Cardiac tamponadechronic total occlusioncoilcomplicationscoronary artery perforationcovered stentembolizationpercutaneous coronary intervention

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