Massive coronary perforation and shock: From appropriate labeling to appropriate calls.
Coronary perforation is a rare, unpredictable and dreaded complication of percutaneous coronary Intervention. With Ellis Grade 3 perforations the only effective treatment includes temporary balloon occlusion of the perforated coronary artery and placement of JOSTENT GraftMaster stent to cover the perforation. The authors describe coronary perforation during proximal right coronary artery (RCA) stenting, resulting in immediate cardiogenic shock. The patient was treated with temporary balloon occlusion of the RCA, reversal of anti-coagulation, sealing of the perforation with a GraftMaster stent, inotropes, intra-aortic balloon counterpulsation (IABC) and surgical drainage the pericardial space. The authors describe the rational of their therapeutic strategy. The methodology and pitfalls of GraftMaster deployment, in patients with massive coronary perforation are discussed. This report also emphasizes, that as opposed to manufactures instructions and all previous manuscripts, GraftMaster can be easily deployed via conventional 6F guiding catheters with internal diameter 0.070 inch (1.8 mm).
Kaluski
Edo
E
Department of Cardiology, University of Medicine and Dentistry, Newark, NJ, USA. ekaluski@gmail.com
Gerula
Christine
C
Randhawa
Preet
P
Haider
Bunyad
B
Klapholz
Marc
M
D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D021721:Balloon Occlusion / Q000379:methods; D003131:Combined Modality Therapy; D003331:Coronary Vessels / Q000293:injuries*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D015607:Stents; D016896:Treatment Outcome