Limits...
Coronary Perforation Complicating Percutaneous Coronary Intervention - A Case Illustration and Review.

Chin Yong A, Wei Chieh JT - ASEAN Heart J (2013)

Bottom Line: Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI).Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management.Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.

ABSTRACT

Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI). Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.

No MeSH data available.


Related in: MedlinePlus

Dual catheter technique was used during stent delivery. PTFE-covered stent dislodgement (arrow) occurred as a result of angulated and tortuous proximal left circumflex.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4544476&req=5

Fig2: Dual catheter technique was used during stent delivery. PTFE-covered stent dislodgement (arrow) occurred as a result of angulated and tortuous proximal left circumflex.

Mentions: A 61-year old man with known condition of ischemic heart disease was admitted for elective PCI to left circumflex artery chronic total occlusion. PCI attempt to left circumflex chronic total occlusion was carried out. Diagnostic angiography showed diffuse calcified occlusion extending from the proximal to distal left circumflex artery with Renthrop classification grade II collaterals from the diagonals filling up the obtuse marginal branches(OM). With a 6 French extra back-up guider and micro-catheter support, attempts were made initially using soft hydrophilic wire (Asahi Fielder 0.014), followed by intermediate tapered tip wire (Boston Scientific PT2 0.014). Subsequently, by using a stiff wire(Asahi Neo Conquest Pro 0.014), lesion was successfully crossed with wire tip placed at the large OM2. After exchanging to a soft wire and placing a second wire in the distal left circumflex, multiple balloon inflations at various sites from proximal left circumflex to the OM2 using 1.5 x 15mm balloon (10 atmosphere) and 2.0 x 15mm balloon (14 atmosphere) were undertaken. This was followed by further dilation proximally with a non-compliant 2.5 x 15 balloon (20 atmosphere) and placement of a 2.5 x 38mm drug-eluting stent (Abbott Vascular Xience Prime 2.5 X 38), stretching from proximal left circumflex to the OM2 branch (14 atmospheric pressure). Angiography post stent deployment showed an Ellis type III coronary artery perforation at the OM2. (Figure 1) Prolonged balloon inflation proximal to the site of perforation failed to seal the perforation. Using dual catheter technique, a second guider(7F) is inserted via left femoral arterial while prolonged balloon inflation was performed through the initial guiding catheter. A second guidewire is then advanced through the second guider, and into the affected OM branch upon balloon deflation for delivery of the covered stent. Attempt to deliver a premounted PTFE covered stent (InSitu Direct- Stent Stent Graft 2.5 x 19mm) however, was unsuccessful as the stent was dislodged due to tortuous proximal left circumflex segment. The stent was later captured and removed by using a microsnare whilst balloon was inflated in the circumflex artery. (Figure 2) Patient began to become hemodynamically unstable with large pericardial effusion visualized on fluoroscopy. Pericardiocentesis was performed and repeat angiography showed persistent type III perforation. The patient was taken for emergency coronary artery repair and CABG. The site of perforation was sought and a 8mm tear at the OM2 was identified. The patient recovered post-surgery with no deficits and was subsequently discharged 10 days later.


Coronary Perforation Complicating Percutaneous Coronary Intervention - A Case Illustration and Review.

Chin Yong A, Wei Chieh JT - ASEAN Heart J (2013)

Dual catheter technique was used during stent delivery. PTFE-covered stent dislodgement (arrow) occurred as a result of angulated and tortuous proximal left circumflex.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4544476&req=5

Fig2: Dual catheter technique was used during stent delivery. PTFE-covered stent dislodgement (arrow) occurred as a result of angulated and tortuous proximal left circumflex.
Mentions: A 61-year old man with known condition of ischemic heart disease was admitted for elective PCI to left circumflex artery chronic total occlusion. PCI attempt to left circumflex chronic total occlusion was carried out. Diagnostic angiography showed diffuse calcified occlusion extending from the proximal to distal left circumflex artery with Renthrop classification grade II collaterals from the diagonals filling up the obtuse marginal branches(OM). With a 6 French extra back-up guider and micro-catheter support, attempts were made initially using soft hydrophilic wire (Asahi Fielder 0.014), followed by intermediate tapered tip wire (Boston Scientific PT2 0.014). Subsequently, by using a stiff wire(Asahi Neo Conquest Pro 0.014), lesion was successfully crossed with wire tip placed at the large OM2. After exchanging to a soft wire and placing a second wire in the distal left circumflex, multiple balloon inflations at various sites from proximal left circumflex to the OM2 using 1.5 x 15mm balloon (10 atmosphere) and 2.0 x 15mm balloon (14 atmosphere) were undertaken. This was followed by further dilation proximally with a non-compliant 2.5 x 15 balloon (20 atmosphere) and placement of a 2.5 x 38mm drug-eluting stent (Abbott Vascular Xience Prime 2.5 X 38), stretching from proximal left circumflex to the OM2 branch (14 atmospheric pressure). Angiography post stent deployment showed an Ellis type III coronary artery perforation at the OM2. (Figure 1) Prolonged balloon inflation proximal to the site of perforation failed to seal the perforation. Using dual catheter technique, a second guider(7F) is inserted via left femoral arterial while prolonged balloon inflation was performed through the initial guiding catheter. A second guidewire is then advanced through the second guider, and into the affected OM branch upon balloon deflation for delivery of the covered stent. Attempt to deliver a premounted PTFE covered stent (InSitu Direct- Stent Stent Graft 2.5 x 19mm) however, was unsuccessful as the stent was dislodged due to tortuous proximal left circumflex segment. The stent was later captured and removed by using a microsnare whilst balloon was inflated in the circumflex artery. (Figure 2) Patient began to become hemodynamically unstable with large pericardial effusion visualized on fluoroscopy. Pericardiocentesis was performed and repeat angiography showed persistent type III perforation. The patient was taken for emergency coronary artery repair and CABG. The site of perforation was sought and a 8mm tear at the OM2 was identified. The patient recovered post-surgery with no deficits and was subsequently discharged 10 days later.

Bottom Line: Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI).Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management.Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.

ABSTRACT

Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI). Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.

No MeSH data available.


Related in: MedlinePlus