Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations-A 10-year Single-center Experience.
BACKGROUND
Coronary perforation during percutaneous coronary intervention is a rare but dreaded complication. The risk factors, optimal management, and outcome remain obscure.


OBJECTIVE
To determine the predisposing factors, optimal management, and preventive strategies. We retrospectively looked at coronary perforations at our catheterization laboratory over the last 10 years. We reviewed patient charts and reports. Two independent operators, in a blinded approach, reviewed all procedural cineangiograms. Data were analyzed by simple statistical methodology.


RESULTS
Nine patients were treated conservatively and six patients were treated with prolonged balloon inflation. Six patients were treated with polytetrafluoroethylene (PTFE)-covered stents. One patient required emergency coronary artery bypass graft. No deaths were reported. Subjects with perforations also had a significantly higher total white blood cell count (means 12,134 versus 6,155, 95 % confidence interval [CI], p< 0.0001, n=22), total absolute neutrophil count (means 74.2 % versus 57.1 %, 95 % CI, p<0.0001, n=22), and neutrophil:lymphocyte ratio (means 3.65 versus 1.50, 95% CI, p<0.0001, n=22).


CONCLUSIONS
Coronary perforations are rare but potentially fatal events. Hypertension, small vessel diameter, high balloon:artery ratio, use of hydrophilic wires, and presence of myocardial bridging appear to be possible risk factors. Most perforations can be treated conservatively or with prolonged balloon inflation using perfusion balloons. Use of PTFE-covered stents could be a life-saving measure in cases of large perforations. Subjects with perforations also had greater systemic inflammation as indicated by elevated white cell counts.
Fellow, Cardiology.
Preeti
P
Chandra
Resident, Internal Medicine, Maimonides Medical Center, 864 49th Street, Apt C11, Brooklyn, NY 11220. E: sauravchatterjeemd@gmail.com.
Saurav
S
Chatterjee
Fellow.
Nishant
N
Koradia
Fellow.
Deepak
D
Thekkoott
Attending.
Bilal
B
Malik
Director of the Cardiac Catheterization Lab.
Robert
R
Frankel
Director of the Cardiac Institute, Division of Cardiology, Dept of Internal Medicine, Maimonides Medical Center.
Jacob
J
Shani