Limits...
Fatal delayed coronary artery perforation after coronary stent implantation.

Kim SH, Moon JY, Sung JH, Kim IJ, Lim SW, Cha DH, Cho SY - Korean Circ J (2012)

Bottom Line: Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions.However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations.To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT
Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

No MeSH data available.


Related in: MedlinePlus

Coronary angiogram after cardiovascular resuscitation due to sudden cardiac arrest in general ward. A: angiogram showed type III coronary perforation with bleeding at the previous stent implantation site (arrow). B: before inflation, first Jo graft stent was placed for the active bleeding site. C: after stenting of two graft stents, the final angiogram during cardiovascular resuscitation showed no additional bleeding.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3369969&req=5

Figure 2: Coronary angiogram after cardiovascular resuscitation due to sudden cardiac arrest in general ward. A: angiogram showed type III coronary perforation with bleeding at the previous stent implantation site (arrow). B: before inflation, first Jo graft stent was placed for the active bleeding site. C: after stenting of two graft stents, the final angiogram during cardiovascular resuscitation showed no additional bleeding.

Mentions: Before angiography, percutaneous cardiopulmonary support was immediately applied via the femoral artery during CPR. Next, the CAG was checked again. Surprisingly, CAG revealed coronary perforation with active bleeding (type III) at the previous stent implantation site (Fig. 2A). Pericardiocentesis was performed successfully and Jo graft stent (3.0×19 mm) was implanted for the active bleeding site (Fig. 2B). However, the leakage of blood still remained. Therefore, we considered another graft stent. However, while preparing for another graft stent, the cardiac arrest redeveloped. The CPR was restarted and we were able to determine what the second problem was. Tension pneumothorax developed during ambu bagging, so we decided to insert the chest tube. Therefore, after insertion of another graft stent (3.5×19 mm), the chest tube was inserted to the pleural cavity by a thoracic surgeon simultaneously. After that, the vital signs recovered and bleeding was controlled (Fig. 2C). Finally, we were able to finish the procedures. The pneumothorax was resolved after 3 days and cardiac function totally recovered within 3 days. However, the brain of the patient was damaged by hypoxic brain injury and he remained in a vegetative state.


Fatal delayed coronary artery perforation after coronary stent implantation.

Kim SH, Moon JY, Sung JH, Kim IJ, Lim SW, Cha DH, Cho SY - Korean Circ J (2012)

Coronary angiogram after cardiovascular resuscitation due to sudden cardiac arrest in general ward. A: angiogram showed type III coronary perforation with bleeding at the previous stent implantation site (arrow). B: before inflation, first Jo graft stent was placed for the active bleeding site. C: after stenting of two graft stents, the final angiogram during cardiovascular resuscitation showed no additional bleeding.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369969&req=5

Figure 2: Coronary angiogram after cardiovascular resuscitation due to sudden cardiac arrest in general ward. A: angiogram showed type III coronary perforation with bleeding at the previous stent implantation site (arrow). B: before inflation, first Jo graft stent was placed for the active bleeding site. C: after stenting of two graft stents, the final angiogram during cardiovascular resuscitation showed no additional bleeding.
Mentions: Before angiography, percutaneous cardiopulmonary support was immediately applied via the femoral artery during CPR. Next, the CAG was checked again. Surprisingly, CAG revealed coronary perforation with active bleeding (type III) at the previous stent implantation site (Fig. 2A). Pericardiocentesis was performed successfully and Jo graft stent (3.0×19 mm) was implanted for the active bleeding site (Fig. 2B). However, the leakage of blood still remained. Therefore, we considered another graft stent. However, while preparing for another graft stent, the cardiac arrest redeveloped. The CPR was restarted and we were able to determine what the second problem was. Tension pneumothorax developed during ambu bagging, so we decided to insert the chest tube. Therefore, after insertion of another graft stent (3.5×19 mm), the chest tube was inserted to the pleural cavity by a thoracic surgeon simultaneously. After that, the vital signs recovered and bleeding was controlled (Fig. 2C). Finally, we were able to finish the procedures. The pneumothorax was resolved after 3 days and cardiac function totally recovered within 3 days. However, the brain of the patient was damaged by hypoxic brain injury and he remained in a vegetative state.

Bottom Line: Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions.However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations.To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT
Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

No MeSH data available.


Related in: MedlinePlus