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Coronary artery perforation treated with multiple bare metal stent implantation.

Baskurt M, Keskin K, Fazlıoğulları O, Ayça B, Kalyoncu M - Postepy Kardiol Interwencyjnej (2013)

Bottom Line: As a general rule severe perforations are treated with covered stents.Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial.We believe that therapy should be individualized.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Medicana Hospitals Bahçelievler, Bahçelievler, Istanbul, Turkey.

ABSTRACT
Although coronary artery perforations are quite rare, when they occur, the consequences are devastating. Treatment options differ according to the type, location and severity of the perforation. As a general rule severe perforations are treated with covered stents. However, when implanting a covered stent is not an option as in our case due to various reasons, multiple bare metal stent implantation may be a good option. Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial. We believe that therapy should be individualized.

No MeSH data available.


Related in: MedlinePlus

Ellis type 3 coronary perforation is seen
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Figure 0003: Ellis type 3 coronary perforation is seen

Mentions: A 55-year-old man was taken to the catheterization laboratory with a history of stable angina pectoris in the last three months. His physical examination, surface ECG, echocardiogram and laboratory tests were within normal limits. At the angiogram, which was performed via the right radial artery, there were two significant lesions in the RCA and LAD. After the informed consent, we decided to open the LAD lesion first. LAD artery was wired with a 0.014 inch Floopy (Asahi Japan) guidewire. The lesion was predilated with a 2.0 mm × 15 mm Sprinter balloon (Medtronic USA) at 12 atm. Then a 3.0 mm × 32 mm Liberte BMS (Boston Scientific, USA) was implanted at 16 atm. Due to plaque shift and residual stenosis at the distal part of the first stent, a second 2.75 mm × 18 mm Nobori (Terumo Japan) drug-eluting stent was implanted at 18 atm overlapping the proximal one (Figure 1). After the control angiography, the mid part of the stented area seemed not fully opened and it was decided to apply postdilation. A 3.0 mm × 15 mm Sprinter balloon was inflated at 18 and then 20 atm. Since the result was not satisfactory, a 3.5 mm × 16 mm Sprinter balloon was once more inflated at 20 atm (Figure 2). During this last inflation, the waist of the balloon suddenly disappeared, giving the impression of full expansion. Further injection revealed Ellis type 3 perforation of the vessel from just beneath the overlapped region (Figure 3).


Coronary artery perforation treated with multiple bare metal stent implantation.

Baskurt M, Keskin K, Fazlıoğulları O, Ayça B, Kalyoncu M - Postepy Kardiol Interwencyjnej (2013)

Ellis type 3 coronary perforation is seen
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927117&req=5

Figure 0003: Ellis type 3 coronary perforation is seen
Mentions: A 55-year-old man was taken to the catheterization laboratory with a history of stable angina pectoris in the last three months. His physical examination, surface ECG, echocardiogram and laboratory tests were within normal limits. At the angiogram, which was performed via the right radial artery, there were two significant lesions in the RCA and LAD. After the informed consent, we decided to open the LAD lesion first. LAD artery was wired with a 0.014 inch Floopy (Asahi Japan) guidewire. The lesion was predilated with a 2.0 mm × 15 mm Sprinter balloon (Medtronic USA) at 12 atm. Then a 3.0 mm × 32 mm Liberte BMS (Boston Scientific, USA) was implanted at 16 atm. Due to plaque shift and residual stenosis at the distal part of the first stent, a second 2.75 mm × 18 mm Nobori (Terumo Japan) drug-eluting stent was implanted at 18 atm overlapping the proximal one (Figure 1). After the control angiography, the mid part of the stented area seemed not fully opened and it was decided to apply postdilation. A 3.0 mm × 15 mm Sprinter balloon was inflated at 18 and then 20 atm. Since the result was not satisfactory, a 3.5 mm × 16 mm Sprinter balloon was once more inflated at 20 atm (Figure 2). During this last inflation, the waist of the balloon suddenly disappeared, giving the impression of full expansion. Further injection revealed Ellis type 3 perforation of the vessel from just beneath the overlapped region (Figure 3).

Bottom Line: As a general rule severe perforations are treated with covered stents.Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial.We believe that therapy should be individualized.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Medicana Hospitals Bahçelievler, Bahçelievler, Istanbul, Turkey.

ABSTRACT
Although coronary artery perforations are quite rare, when they occur, the consequences are devastating. Treatment options differ according to the type, location and severity of the perforation. As a general rule severe perforations are treated with covered stents. However, when implanting a covered stent is not an option as in our case due to various reasons, multiple bare metal stent implantation may be a good option. Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial. We believe that therapy should be individualized.

No MeSH data available.


Related in: MedlinePlus