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Grade 3 coronary artery perforations in chronic total occlusion-percutaneous coronary intervention: Mechanisms,

Marco Pavani1,2, Enrico Cerrato1,2, Alfonso Franzè1,2

  • 1Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 10, 2022
PubMed

Insights

Grade III coronary perforations (G3-CP) during chronic total occlusion percutaneous coronary intervention (CTO-PCI) have similar outcomes to non-CTO PCI. This study found comparable in-hospital and long-term mortality and major adverse events.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Coronary artery perforations, particularly Grade III (G3-CP), are a known complication of percutaneous coronary intervention (PCI).
  • The specific impact and outcomes of G3-CP during chronic total occlusion PCI (CTO-PCI) remain less understood compared to non-CTO PCI procedures.

Purpose of the Study:

  • To assess the incidence and clinical impact of G3-CP in patients undergoing CTO-PCI versus non-CTO PCI.
  • To compare in-hospital and long-term outcomes following G3-CP in both CTO-PCI and non-CTO PCI cohorts.

Main Methods:

  • Retrospective analysis of 7773 CTO-PCI and 98,819 non-CTO PCI procedures from 10 European centers.
  • Evaluation of G3-CP incidence, characteristics, procedural details (including wire usage), and patient outcomes (mortality, major adverse events).

Main Results:

  • G3-CP occurred more frequently in CTO-PCI (1.1%) than non-CTO PCI (0.22%).
  • Wire-induced G3-CP was more common in CTO-PCI, especially with dedicated tapered wires.
  • Intra-procedural, in-hospital, and 24-month mortality and major adverse events (MAE) were similar between CTO-PCI and non-CTO PCI groups following G3-CP.

Conclusions:

  • Grade III coronary perforations during CTO-PCI do not appear to confer worse in-hospital or long-term outcomes compared to G3-CP during non-CTO PCI.
  • Careful wire selection may be important in minimizing G3-CP during complex CTO interventions.
Abstract

Keywords:
BLEE-bleedingCAD-coronary artery diseaseCOMI-complicationsCTOCTO-percutaneous coronary interventionPCIPCI-percutaneous coronary intervention (PCI)PCIC-percutaneous coronary interventioncomplex PCI

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