Fatal complication, rescue therapy; covered stent for coronary artery perforation

Abdulmelik Yıldız, Ahmet Karakurt, Atila Bitigen, Bayram Bağırtan

Department of Cardiology, Faculty of Medicine, Kafkas University, Kars, Turkey.
Medikal Park, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey;.
Private Avrupa Safak Hospital, Istanbul, Turkey.
Private Medikalpark Hospital, Istanbul, Turkey.

DOI: 10.4236/health.2013.57A3001                

Abstract

Introduction: Although coronary perforation is a rare complication observed during intervenetional procedures, it has a considerably high mortality rate. The prevelance of coronary perforation has been reported to be 0.20%-0.6%. Its sudden development, the patient’s agitation and development of rapid collapse render intervention difficult. Materials and Method: The presence of perfusion balloon and covered stent in clinics is life-saving. In the present study, we retrospectively reviewed 17 cases with coronary artery perforation that were treated between 2009 and 2012. Of these patients, 10 (58.8%) were men and 7 (41.2%) were women; the median age was 62.8 ± 8.3 years. The coronary artery perforation resulted from guide wire in 23.5%, balloon dilatation in 58.8% and stent implantation in 17.6%. All the lesions were either type B or C lesions. Results: The extensiveness of perforation was Ellis grade I in 23.5%, grade II in 47.1% and grade III in 29.4% of the cases. In the treatment of the perforation, polytetrafluoroethylene-covered stent graft was implemented in 9 (52.9%) patients, whilst conventional and emergency surgical therapy was performed in 8 (47.1%) patients. Grade I perforations occurred due to the guide wire and were managed with conventional therapy (p < 0.05). Grade II and III perforations resulted from balloon and stent. The majority of these patients were inserted Graft Stent (stent graft in 52.9% and conventional therapy in 23.5% of the cases (p < 0.05). Although all the stent grafts were successfully implanted, the complete control of bleeding was achieved only in 77.7% of the patients. Mortality was not observed in grade I perforation, whilst all cases resulted in mortality had grade III perforation. Conclusion: These data indicate that there is a need for further advanced technology in the coronary artery perforation despite of currently available therapeutic options.

Keywords

Percutaneous Coronary Artery Intervention; Coronary Artery Perforation; Covered Stent

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Chou, G.L., Pinnow, E., Flood, R., Bonnet, Y., Tebeica, M., Waksman, R., et al. (2000) Incidence, management and outcome of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 86, 680-682. doi:10.1016/S0002-9149(00)01053-5
[2]	Kimbiris, D., Iskandrian, A.S., Goel, I., Bemis, C.E., Gehl, L., Owens, J., et al. (1982) Transluminal coronary angioplasty complicated by coronary artery perforation. Catheterization and Cardiovascular Diagnosis, 8, 481-487. doi:10.1002/ccd.1810080507
[3]	Ellis, S.G., Ajluni, S., Arnold, A.Z., Popma, J.J., Bittl, J.A., Eigler, N.L., et al. (1994) Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation, 90, 2725-2730. doi:10.1161/01.CIR.90.6.2725
[4]	Topaz, O., Cowley, M.J. and Vetrovec, G.W. (1992) Coronary artery perforation during angioplasty: Angiographic detection and demonstration of complete healing. Catheterization and Cardiovascular Diagnosis, 27, 284-288. doi:10.1002/ccd.1810270408
[5]	Yorgun, H., Canpolat, U., Aytemir, K. and Oto, A. (2012) Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention. Cardiology Journal, 19, 639-642.
[6]	Ryan, T.J., Faxon, D.P., Gunnar, R.M., Kennedy, J.W., King 3rd, S.B., Loop, F.D., et al. (1988) Guidelines for PTCA. A report of American College of Cardiology/American Heart Association task force of assessment of diagnostic and therapeutic cardiovasculer procedures (subcommitee of percutaneous transluminal coronary angioplasty). Circulation, 78, 486-502. doi:10.1161/01.CIR.78.2.486
[7]	Al-Mukhaini, M., Panduranga, P., Sulaiman, K., Riyami, A.A., Deeb, M. and Riyami, M.B. (2011) Coronary perforation and covered stents: An update and review. Heart View, 12, 63-70.
[8]	Gunning, M.G., Williams, I.L., Jewitt, D.E., Shah, A.M., Wainwright, R.J. and Thomas, M.R. (2002) Coronary artery perforation during percutaneous intervention: Incidence and outcome. Heart, 88, 495-498. doi:10.1136/heart.88.5.495
[9]	Von Sohsten, R., Kopistansky, C., Cohen, M. and Kussmaul, W.G. (2000) Cardiac tamponade in the new device era: evaluation of 6999 consecutive percutaneous coronary interventions. American Heart Journal, 140, 279-283. doi:10.1067/mhj.2000.107996
[10]	Joint Working Group on Coronary Angioplasty of the British Cardiac Society and British Cardiovascular Intervention Society (2000) Coronary angioplasty: Guidelines for good practice and training. Heart, 83, 224-235. doi:10.1136/heart.83.2.224
[11]	Shimony, A., Zahger, D., Van Straten, M., Shalev, A., Gilutz, H., Ilia, R., et al. (2009) Incidence, risk factors, management and out-comes of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 104, 1674-1677. doi:10.1016/j.amjcard.2009.07.048
[12]	Stankovic, G., Orlic, D., Corvaja, N., Airoldi, F., Chieffo, A., Spanos, V., et al. (2004) Incidence, predictors, inhospital, and late outcomes of coronary artery perforations. American Journal of Cardiology, 93, 213-216. doi:10.1016/j.amjcard.2003.09.042
[13]	Javaid, A., Buch, A.N., Satler, L.F., Kent, K.M., Suddath, W.O., Lindsay Jr., J., et al. (2006) Management and outcomes of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 98, 911-914. doi:10.1016/j.amjcard.2006.04.032
[14]	Alexandra, J.L, Yi-ming, Y., Yosef, K., Costa, R.A., Pietras, C., Tsuchiya, Y., et al. (2006) Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. American Journal of Cardiology, 98, 370-374. doi:10.1016/j.amjcard.2006.02.041
[15]	Briguori, C., Nishida, T., Anzuini, A., Di Mario, C., Grube, E., Colombo, A., et al. (2000) Emergency polytetrafluoroethylene covered stent implantation to treat coronary ruptures. Circulation, 102, 3028-3031. doi:10.1161/01.CIR.102.25.3028
[16]	Romaguera, R. and Waksman, R. (2011) Covered stents for coronary perforations: Is there enough evidence? Catheterization and Cardiovascular Interventions, 78, 246-253. doi:10.1002/ccd.23017
[17]	Mahmud, E. and Douglas Jr., J.S. (2001) Coil embolization for successful treatment of perforation of chronically occluded proximal coronary artery. Catheterization and Cardiovascular Interventions, 53, 549-552. doi:10.1002/ccd.1221
[18]	Shimony, A., Joseph, L., Mottillo, S. and Eisenberg, M.J. (2011) Systematic review/meta-analysis coronary artery perforation during percutaneous coronary intervention: A systematic review and meta-analysis. Canadian Journal of Cardiology, 27, 843-850. doi:10.1016/j.cjca.2011.04.014