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Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)-Multicenter
Grzegorz Sobieszek1, Bartosz Zięba1, Wojciech Dworzański2
1Department of Cardiology, 1st Military Hospital, 20-049 Lublin, Poland.
Insights
The cut balloon technique (CBT) effectively seals coronary artery perforations. This method is safe and efficient, often requiring only one or two balloon fragments for embolization.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Cardiovascular Interventions
Background:
- Iatrogenic distal coronary artery perforation is a serious complication during cardiac procedures.
- Limited data exist on using the cut balloon technique (CBT) for embolizing coronary perforations.
Purpose of the Study:
- To evaluate the safety and efficacy of the cut balloon technique (CBT) for treating distal coronary artery perforations.
- To assess in-hospital outcomes associated with CBT in this patient population.
Main Methods:
- A multicenter study included 26 patients with coronary perforations treated with CBT between 2017 and 2023.
- Collected data on clinical, angiographic, and procedural characteristics, as well as in-hospital outcomes.
Main Results:
- CBT successfully treated 25 distal coronary perforations and one septal perforation.
- Most perforations (40%) were in the left anterior descending artery.
- Favorable in-hospital outcomes were observed, with only 16% requiring pericardiocentesis and no emergency surgeries or cardiac deaths.
Conclusions:
- The cut balloon technique (CBT) is a safe, efficient, and easily implemented method for embolizing coronary perforations.
- One or two balloon fragments are often sufficient to seal perforations, potentially avoiding the need for specialized devices.
Background:
Iatrogenic distal coronary artery perforation can be a life-threatening complication. While there are different dedicated devices for the embolization of distal perforations, there are scarce data about the embolization using the fragmented balloon catheter, the so-called cut balloon technique (CBT).
Methods:
We included consecutive patients with distal coronary perforations treated with CBT in four cardiac centers between 2017 and 2023. Clinical, angiographic and procedural characteristics as well as in-hospital outcomes were recorded.
Results:
Twenty-six patients (68% men, mean age: 71 ± 10.6 years) with 25 distal coronary perforations and one septal collateral perforation were included. Eleven patients (42%) had elective percutaneous coronary intervention, while fifteen patients (58%) were treated for acute coronary syndrome. The site of perforation was most frequently distributed in the left anterior descending artery (40%), followed by the circumflex artery (28%) and right coronary artery (24%). The diameter of balloons for CBT ranged from 1.5 to 4.0 mm, with most balloons (76%) being either 2.0 or 2.5 mm in diameter. Most balloons (88%) were previously used for lesion predilatation. The numbers of cut balloons needed to seal the perforation were 1, 2 and ≥3 in 48%, 20% and 32% of cases, respectively. The in-hospital prognosis was favorable, with cardiac tamponade requiring pericardiocentesis in only four (16%) patients. Neither emergency surgery nor cardiac death occurred.
Conclusions:
CBT is a safe, efficient and easy-to-implement technique for the embolization of coronary perforations. Most distal coronary perforations can be sealed with one or two fragments of cut balloons, obviating the need for additional devices.
