Fatal complication, rescue therapy; covered stent for coronary artery perforation


Introduction: Although coronary perforation is a rare complication observed during intervenetional procedures, it has a considerably high mortality rate. The prevelance of coronary perforation has been reported to be 0.20%-0.6%. Its sudden development, the patient’s agitation and development of rapid collapse render intervention difficult. Materials and Method: The presence of perfusion balloon and covered stent in clinics is life-saving. In the present study, we retrospectively reviewed 17 cases with coronary artery perforation that were treated between 2009 and 2012. Of these patients, 10 (58.8%) were men and 7 (41.2%) were women; the median age was 62.8 ± 8.3 years. The coronary artery perforation resulted from guide wire in 23.5%, balloon dilatation in 58.8% and stent implantation in 17.6%. All the lesions were either type B or C lesions. Results: The extensiveness of perforation was Ellis grade I in 23.5%, grade II in 47.1% and grade III in 29.4% of the cases. In the treatment of the perforation, polytetrafluoroethylene-covered stent graft was implemented in 9 (52.9%) patients, whilst conventional and emergency surgical therapy was performed in 8 (47.1%) patients. Grade I perforations occurred due to the guide wire and were managed with conventional therapy (p < 0.05). Grade II and III perforations resulted from balloon and stent. The majority of these patients were inserted Graft Stent (stent graft in 52.9% and conventional therapy in 23.5% of the cases (p < 0.05). Although all the stent grafts were successfully implanted, the complete control of bleeding was achieved only in 77.7% of the patients. Mortality was not observed in grade I perforation, whilst all cases resulted in mortality had grade III perforation. Conclusion: These data indicate that there is a need for further advanced technology in the coronary artery perforation despite of currently available therapeutic options.

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Yıldız, A. , Karakurt, A. , Bitigen, A. and Bağırtan, B. (2013) Fatal complication, rescue therapy; covered stent for coronary artery perforation. Health, 5, 1-5. doi: 10.4236/health.2013.57A3001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Chou, G.L., Pinnow, E., Flood, R., Bonnet, Y., Tebeica, M., Waksman, R., et al. (2000) Incidence, management and outcome of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 86, 680-682. doi:10.1016/S0002-9149(00)01053-5
[2] Kimbiris, D., Iskandrian, A.S., Goel, I., Bemis, C.E., Gehl, L., Owens, J., et al. (1982) Transluminal coronary angioplasty complicated by coronary artery perforation. Catheterization and Cardiovascular Diagnosis, 8, 481-487. doi:10.1002/ccd.1810080507
[3] Ellis, S.G., Ajluni, S., Arnold, A.Z., Popma, J.J., Bittl, J.A., Eigler, N.L., et al. (1994) Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation, 90, 2725-2730. doi:10.1161/01.CIR.90.6.2725
[4] Topaz, O., Cowley, M.J. and Vetrovec, G.W. (1992) Coronary artery perforation during angioplasty: Angiographic detection and demonstration of complete healing. Catheterization and Cardiovascular Diagnosis, 27, 284-288. doi:10.1002/ccd.1810270408
[5] Yorgun, H., Canpolat, U., Aytemir, K. and Oto, A. (2012) Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention. Cardiology Journal, 19, 639-642.
[6] Ryan, T.J., Faxon, D.P., Gunnar, R.M., Kennedy, J.W., King 3rd, S.B., Loop, F.D., et al. (1988) Guidelines for PTCA. A report of American College of Cardiology/American Heart Association task force of assessment of diagnostic and therapeutic cardiovasculer procedures (subcommitee of percutaneous transluminal coronary angioplasty). Circulation, 78, 486-502. doi:10.1161/01.CIR.78.2.486
[7] Al-Mukhaini, M., Panduranga, P., Sulaiman, K., Riyami, A.A., Deeb, M. and Riyami, M.B. (2011) Coronary perforation and covered stents: An update and review. Heart View, 12, 63-70.
[8] Gunning, M.G., Williams, I.L., Jewitt, D.E., Shah, A.M., Wainwright, R.J. and Thomas, M.R. (2002) Coronary artery perforation during percutaneous intervention: Incidence and outcome. Heart, 88, 495-498. doi:10.1136/heart.88.5.495
[9] Von Sohsten, R., Kopistansky, C., Cohen, M. and Kussmaul, W.G. (2000) Cardiac tamponade in the new device era: evaluation of 6999 consecutive percutaneous coronary interventions. American Heart Journal, 140, 279-283. doi:10.1067/mhj.2000.107996
[10] Joint Working Group on Coronary Angioplasty of the British Cardiac Society and British Cardiovascular Intervention Society (2000) Coronary angioplasty: Guidelines for good practice and training. Heart, 83, 224-235. doi:10.1136/heart.83.2.224
[11] Shimony, A., Zahger, D., Van Straten, M., Shalev, A., Gilutz, H., Ilia, R., et al. (2009) Incidence, risk factors, management and out-comes of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 104, 1674-1677. doi:10.1016/j.amjcard.2009.07.048
[12] Stankovic, G., Orlic, D., Corvaja, N., Airoldi, F., Chieffo, A., Spanos, V., et al. (2004) Incidence, predictors, inhospital, and late outcomes of coronary artery perforations. American Journal of Cardiology, 93, 213-216. doi:10.1016/j.amjcard.2003.09.042
[13] Javaid, A., Buch, A.N., Satler, L.F., Kent, K.M., Suddath, W.O., Lindsay Jr., J., et al. (2006) Management and outcomes of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology, 98, 911-914. doi:10.1016/j.amjcard.2006.04.032
[14] Alexandra, J.L, Yi-ming, Y., Yosef, K., Costa, R.A., Pietras, C., Tsuchiya, Y., et al. (2006) Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. American Journal of Cardiology, 98, 370-374. doi:10.1016/j.amjcard.2006.02.041
[15] Briguori, C., Nishida, T., Anzuini, A., Di Mario, C., Grube, E., Colombo, A., et al. (2000) Emergency polytetrafluoroethylene covered stent implantation to treat coronary ruptures. Circulation, 102, 3028-3031. doi:10.1161/01.CIR.102.25.3028
[16] Romaguera, R. and Waksman, R. (2011) Covered stents for coronary perforations: Is there enough evidence? Catheterization and Cardiovascular Interventions, 78, 246-253. doi:10.1002/ccd.23017
[17] Mahmud, E. and Douglas Jr., J.S. (2001) Coil embolization for successful treatment of perforation of chronically occluded proximal coronary artery. Catheterization and Cardiovascular Interventions, 53, 549-552. doi:10.1002/ccd.1221
[18] Shimony, A., Joseph, L., Mottillo, S. and Eisenberg, M.J. (2011) Systematic review/meta-analysis coronary artery perforation during percutaneous coronary intervention: A systematic review and meta-analysis. Canadian Journal of Cardiology, 27, 843-850. doi:10.1016/j.cjca.2011.04.014

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