Coronary Artery Perforation During PCI: Mechanisms, Management, and Outcomes From a 10-Year Experience

Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention, with a mortality rate of 10% to 20%. Its relevance is increasing with procedural complexity and expanded device use.

We present a 10-year, single-center case series of 21 CAP cases, highlighting 5 key cases: type III CAP treated with a covered stent complicated by side branch occlusion; calcified perforation complicated by stent thrombosis; distal wire perforation with fatal outcome; chronic total occlusion-related CAP managed with coiling and surgery; and type IV CAP with delayed deterioration. Overall, type III CAP was most common (52%), and the left anterior descending artery was most frequently involved (57%). Management included covered stent in 71%, coiling in 14%, and surgery in 2 cases. Four patients died, and 2 patients developed stent thrombosis or in-stent restenosis.

This series emphasizes CAP mechanisms; treatment strategies; and the importance of timely recognition, imaging guidance, and institutional preparedness.