Coronary artery perforation during percutaneous intervention: incidence and outcome.
OBJECTIVE
To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation.


METHODS
Tertiary referral centre.


METHODS
The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%).


RESULTS
In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent.


CONCLUSIONS
Coronary artery perforation with sequelae during intervention is rare--26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not risk-free procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.
Gunning
M G
MG
Department of Cardiology, Kings College Hospital, London, UK. gunningmark@hotmail.com
Williams
I L
IL
Jewitt
D E
DE
Shah
A M
AM
Wainwright
R J
RJ
Thomas
M R
MR
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D017225:Atherectomy, Coronary / Q000009:adverse effects; D002305:Cardiac Tamponade / Q000209:etiology; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012421:Rupture / Q000209:etiology
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab