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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

After second bare metal stent implantation, there is no more contrast extravasation into the pericardial space. This is evaluated as complete sealing of the coronary perforation
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Figure 0005: After second bare metal stent implantation, there is no more contrast extravasation into the pericardial space. This is evaluated as complete sealing of the coronary perforation

Mentions: Because of continuous leakage, we decided to implant a BMS at the perforation site since a covered stent was not available in the laboratory. A 3.0 mm × 16 mm Liberte BMS was implanted at 16 atm which diminished the leakage (Figure 4). In order to seal the perforation completely, a second 3.0 mm × 16 mm Liberte BMS was implanted at 16 atm at the same site. Control angiography showed no extravasation (Figure 5). After that the patient exhibited shortness of breath and his blood pressure dropped from 130/70 mm Hg to 70/40 mm Hg along with tachycardia. Emergent echocardiography revealed 0.7 cm pericardial effusion with right heart compromise. This was considered as cardiac tamponade. Immediate puncture and drainage of 50 ml pericardial hematoma with a 6 Fr sheath corrected blood pressure, tachycardia and dyspnea. One last shot showed no signs of perforation and the patient transferred to the coronary care unit for further therapy leaving the sheath in place in case of tamponade recurrence.


Coronary artery perforation treated with multiple bare metal stent implantation.

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

After second bare metal stent implantation, there is no more contrast extravasation into the pericardial space. This is evaluated as complete sealing of the coronary perforation
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0005: After second bare metal stent implantation, there is no more contrast extravasation into the pericardial space. This is evaluated as complete sealing of the coronary perforation
Mentions: Because of continuous leakage, we decided to implant a BMS at the perforation site since a covered stent was not available in the laboratory. A 3.0 mm × 16 mm Liberte BMS was implanted at 16 atm which diminished the leakage (Figure 4). In order to seal the perforation completely, a second 3.0 mm × 16 mm Liberte BMS was implanted at 16 atm at the same site. Control angiography showed no extravasation (Figure 5). After that the patient exhibited shortness of breath and his blood pressure dropped from 130/70 mm Hg to 70/40 mm Hg along with tachycardia. Emergent echocardiography revealed 0.7 cm pericardial effusion with right heart compromise. This was considered as cardiac tamponade. Immediate puncture and drainage of 50 ml pericardial hematoma with a 6 Fr sheath corrected blood pressure, tachycardia and dyspnea. One last shot showed no signs of perforation and the patient transferred to the coronary care unit for further therapy leaving the sheath in place in case of tamponade recurrence.

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