Acute and long-term outcome after coronary artery perforation during percutaneous coronary interventions.
BACKGROUND
Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions (PCI).


METHODS
We reviewed our database for cases of overt coronary perforation during PCI procedures. Hospital charts, procedural reports, and coronary angiograms of these patients were reviewed, with particular emphasis on mechanisms of perforation, management of the complication, and clinical outcome.


RESULTS
Between 01/1998 and 12/2003, a total of 19 cases (mean age: 66+/-8 years, 13 male) of coronary perforation occurred during 6433 PCI procedures performed within this period (incidence: 0.3%). In 12/19 (63%) cases, perforation occurred during recanalisation procedures of chronic total occlusions of coronary arteries. In all but one patient, non-surgical management was attempted: 2 out of 19 (11%) patients were treated conservatively by reversal of heparin anticoagulation. Prolonged balloon inflation at the perforation site was applied in 10/19 (53%) patients. Six (32%) patients received stents (5 of them received covered stentgrafts), 3 (16%) patients developed cardiac tamponade requiring percardiocentesis, and only 2 (11%) patients underwent bailout surgical repair. There were 2 (11%) deaths early after the procedure.


CONCLUSIONS
Coronary perforation during PCI is a rare complication, but is associated with significant morbidity and mortality. In the majority of patients, non-surgical management is both feasible and associated with a high success-rate.
Eggebrecht
H
H
Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. holger.eggebrecht@uni-essen.de
Ritzel
A
A
von Birgelen
C
C
Schermund
A
A
Naber
C
C
Böse
D
D
Baumgart
D
D
Bartel
T
T
Haude
M
M
Erbel
R
R
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D021721:Balloon Occlusion; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D002404:Catheterization; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome