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Subclavian Artery Perforation and Mediastinal Hematoma Following Transradial Percutaneous Coronary Intervention

Gaurav S Gulsin1, Hussein Taqi1, Tariq Azeem1

  • 1Department of Cardiology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trust, Derby, United Kingdom.

JACC. Case Reports
|August 17, 2021
PubMed

Insights

Subclavian artery perforation with mediastinal hematoma after percutaneous coronary intervention can be managed conservatively. Registry data suggest good long-term outcomes without surgical repair for similar injuries.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
  • Iatrogenic injuries, such as subclavian artery perforation, are rare but serious complications of PCI.
  • Mediastinal hematoma can result from arterial perforation, posing significant clinical challenges.

Observation:

  • A case of subclavian artery perforation leading to mediastinal hematoma following elective PCI is presented.
  • The patient's condition was managed conservatively, avoiding invasive surgical repair.
  • No specific outcome data for subclavian artery injury post-PCI were available.

Findings:

  • Registry data on iatrogenic aortic dissection indicate favorable long-term outcomes without vascular repair.
  • This suggests a potentially similar favorable prognosis for subclavian artery injuries managed conservatively.
  • The conservative approach was deemed appropriate given the available evidence for related vascular injuries.

Implications:

  • Conservative management may be a viable option for select cases of subclavian artery perforation with mediastinal hematoma post-PCI.
  • Further research and data collection are needed to establish definitive guidelines for managing this specific complication.
  • This case highlights the importance of considering non-operative strategies for iatrogenic arterial injuries when supported by analogous data.

Keywords:
CT, computed tomographyECG, electrocardiogramPCI, percutaneous coronary interventioncomplicationdissectionmyocardial revascularization

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