Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview
BackgroundCoronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11‐year single‐center experience. Methods and ResultsFrom Febru...
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| Format: | Article |
| Language: | English |
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Wiley
2017-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007049 |
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| author | Miguel E. Lemmert Rutger J. van Bommel Roberto Diletti Jeroen M. Wilschut Peter P. de Jaegere F. Zijlstra Joost Daemen Nicolas M. Van Mieghem |
| author_facet | Miguel E. Lemmert Rutger J. van Bommel Roberto Diletti Jeroen M. Wilschut Peter P. de Jaegere F. Zijlstra Joost Daemen Nicolas M. Van Mieghem |
| author_sort | Miguel E. Lemmert |
| collection | DOAJ |
| description | BackgroundCoronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11‐year single‐center experience. Methods and ResultsFrom February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62.7% were male. Treated lesion type was B2/C in 94.6%, and 31.3% were chronic total occlusions. Nonworkhorse guidewires were applied in 74.3%. CAP types were Ellis type I in 2.9%, Ellis type II in 40.4%, Ellis type III in 54.8%, and Ellis type III cavity spilling in 1.9%. CAP treatment was conservative (including prolonged balloon inflation) in 73.3%. Covered stents, coiling, and fat embolization were used in 24.0%, 0.7%, and 2.0%, respectively. Pericardiocentesis for tamponade was required for 72 patients (48.0%), of whom 28 were initially unrecognized. Twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. Periprocedural myocardial infarction occurred in 34.0%, and in‐hospital all‐cause mortality was 8.0%. All‐cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year. ConclusionsCAP is a rare complication of percutaneous coronary intervention, but morbidity and mortality are considerable. Early recognition and adequate management are of paramount importance. |
| first_indexed | 2024-12-14T07:08:06Z |
| format | Article |
| id | doaj.art-693bc23194f844e78074108761c6f49a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T07:08:06Z |
| publishDate | 2017-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-693bc23194f844e78074108761c6f49a2022-12-21T23:12:04ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-09-016910.1161/JAHA.117.007049Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical OverviewMiguel E. Lemmert0Rutger J. van Bommel1Roberto Diletti2Jeroen M. Wilschut3Peter P. de Jaegere4F. Zijlstra5Joost Daemen6Nicolas M. Van Mieghem7Thoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsThoraxcenter, Erasmus Medical Center, Rotterdam, NetherlandsBackgroundCoronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11‐year single‐center experience. Methods and ResultsFrom February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62.7% were male. Treated lesion type was B2/C in 94.6%, and 31.3% were chronic total occlusions. Nonworkhorse guidewires were applied in 74.3%. CAP types were Ellis type I in 2.9%, Ellis type II in 40.4%, Ellis type III in 54.8%, and Ellis type III cavity spilling in 1.9%. CAP treatment was conservative (including prolonged balloon inflation) in 73.3%. Covered stents, coiling, and fat embolization were used in 24.0%, 0.7%, and 2.0%, respectively. Pericardiocentesis for tamponade was required for 72 patients (48.0%), of whom 28 were initially unrecognized. Twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. Periprocedural myocardial infarction occurred in 34.0%, and in‐hospital all‐cause mortality was 8.0%. All‐cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year. ConclusionsCAP is a rare complication of percutaneous coronary intervention, but morbidity and mortality are considerable. Early recognition and adequate management are of paramount importance.https://www.ahajournals.org/doi/10.1161/JAHA.117.007049complicationcoronary perforationcoronary repairpercutaneous coronary interventionpericardiocentesis |
| spellingShingle | Miguel E. Lemmert Rutger J. van Bommel Roberto Diletti Jeroen M. Wilschut Peter P. de Jaegere F. Zijlstra Joost Daemen Nicolas M. Van Mieghem Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease complication coronary perforation coronary repair percutaneous coronary intervention pericardiocentesis |
| title | Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview |
| title_full | Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview |
| title_fullStr | Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview |
| title_full_unstemmed | Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview |
| title_short | Clinical Characteristics and Management of Coronary Artery Perforations: A Single‐Center 11‐Year Experience and Practical Overview |
| title_sort | clinical characteristics and management of coronary artery perforations a single center 11 year experience and practical overview |
| topic | complication coronary perforation coronary repair percutaneous coronary intervention pericardiocentesis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007049 |
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