title: Coronary perforation during percutaneous coronary intervention.
abstract: Coronary perforation is an undesirable complication during percutaneous coronary intervention (PCI). We reviewed the cases of overt coronary perforation in our institute and analyzed their clinical backgrounds, the characteristics of the target lesion, management, and clinical outcomes. Between 1991 and 2005, we experienced 12 cases (0.35%) of coronary perforation in a total of 3415 PCI procedures. The perforation occurred during the use of debulking devices in 3 cases, immediately after stenting in 2, immediately after postdilatation of the stent in 2, and during wiring in 3 cases. Restoration was attempted by long inflation of a balloon in 7 cases, implantation of a covered stent graft in 1, and emergency surgical repair in 1 case. Subsequent cardiac tamponade occurred in 3 patients who required pericardiocentesis, and 1 patient died due to congestive heart failure. Administration of protamine was effective in stopping the bleeding in 6 patients, whereas continuation of antiplatelet therapy resulted in no overt rebleeding. Coronary perforation during PCI is a rare complication but is associated with significant morbidity and mortality. Intravenous administration of protamine is effective when it is used in conjunction with nonsurgical devices for initial management of perforation.
authors: First Department of Internal Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
authors: Akihiro
authors: A
authors: Shirakabe
authors: Hitoshi
authors: H
authors: Takano
authors: Shunichi
authors: S
authors: Nakamura
authors: Arifumi
authors: A
authors: Kikuchi
authors: Asako
authors: A
authors: Sasaki
authors: Eisei
authors: E
authors: Yamamoto
authors: Shuji
authors: S
authors: Kawashima
authors: Gen
authors: G
authors: Takagi
authors: Nobuhiko
authors: N
authors: Fujita
authors: Satoshi
authors: S
authors: Aoki
authors: Kuniya
authors: K
authors: Asai
authors: Masatomo
authors: M
authors: Yoshikawa
authors: Koji
authors: K
authors: Kato
authors: Takeshi
authors: T
authors: Yamamoto
authors: Morimasa
authors: M
authors: Takayama
authors: Teruo
authors: T
authors: Takano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D019160:Endosonography; D005260:Female; D006494:Heparin Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D011379:Prognosis; D011479:Protamines / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D012421:Rupture
chemical_list: D006494:Heparin Antagonists; D011479:Protamines