title: Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era.
abstract: BACKGROUND
  Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa).
  
  
  METHODS
  We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined.
  
  
  RESULTS
  A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died.
  
  
  CONCLUSIONS
  Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, Hines V.A. Hospital, Maywood, Illinois, USA.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Ramana
authors.forename: Dinesh
authors.initials: D
authors.lastname: Arab
authors.forename: Dominique
authors.initials: D
authors.lastname: Joyal
authors.forename: Lowell
authors.initials: L
authors.lastname: Steen
authors.forename: Leslie
authors.initials: L
authors.lastname: Cho
authors.forename: Bruce
authors.initials: B
authors.lastname: Lewis
authors.forename: Jayson
authors.initials: J
authors.lastname: Liu
authors.forename: Henry
authors.initials: H
authors.lastname: Loeb
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Leya
mesh_terms: D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D017225:Atherectomy, Coronary / Q000009:adverse effects*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D015994:Incidence; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab