scholarly journals Looped wire advancement—not always safe! Fat—not so useless! a case series

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Atit A Gawalkar ◽  
Navreet Singh ◽  
Ankush Gupta ◽  
Parag Barwad

Abstract Background Coronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it. Case summary We hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP. Discussion Distal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.

Author(s):  
Ashok Kumar Thakur ◽  
Puneet Aggarwal ◽  
Rajeev Bharadwaj ◽  
Bhagya Narayan Pandit ◽  
Ranjit Kumar Nath

Percutaneous Coronary Intervention (PCI) is now the standard of care in patients with coronary artery disease. With advances in modern technology, the success of PCI has relatively increased, and so is its complication, specifically in complex coronary intervention. Coronary perforation is one of the most dreadful and life-threatening complications of PCI. The most vital step in the management of coronary perforation is its identification and quick action. Multiple methods for management are now recommended in the literature, but the mainstay of treatment is still prevention. This review discusses the incidence, risk factors, prevention, identification, and management of Coronary Artery Perforation (CAP).


2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Xiangfei Wang ◽  
Junbo Ge

Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.


2020 ◽  
Vol 09 (01) ◽  
pp. e11-e14
Author(s):  
Maximilian Vondran ◽  
Tamer Ghazy ◽  
Terezia Bogdana Andrási ◽  
Jürgen Graff ◽  
Ardawan Julian Rastan

AbstractCoronary artery perforation secondary to percutaneous coronary intervention (PCI) is a rare, but a potentially life-threatening complication. There is a misconception that cardiac tamponade rarely occurs in patients with prior coronary artery bypass grafting (CABG). We first describe a giant right ventricular intramural hematoma following PCI via a saphenous vein graft to treat a distal stenosis of the right coronary artery, and its successful treatment with redo cardiac surgery. Complex elective PCIs on patients after CABG should be performed in specialized centers with a well-established heart team that has the expertise to treat any of the potential complications.


2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Berkay Ekici ◽  
Aycan Fahri Erkan ◽  
Utku Kütük ◽  
Hasan Fehmi Töre

Perforation of coronary arteries is a relatively rare yet life-threatening complication of percutaneus coronary interventions and is encountered in approximately 0.5% of these procedures. According to the type of coronary perforation, various methods of correction are employed, ranging from conservative approach to emergency cardiac surgery. Coronary stent-grafts are composed of two metal stents and a polytetrafluoroethylene layer between them. Advent of such stents enabled efficient endovascular repair of coronary artery perforation. We present a case of coronary artery perforation which had occurred during stent implantation for the treatment of a bridged segment in the distal portion of the left anterior descending artery. This perforation was successfully managed by implanting a stent-graft.


Author(s):  
Marcos Oliveira ◽  
Valter Trigueiro ◽  
Igor Batista ◽  
Adriano Caixeta

Coronary artery perforation is a rare but potentially lethal complication of percutaneous coronary intervention, mainly due to hemodynamic compromise secondary to cardiac tamponade development. All interventional cardiologists must thus be able to promptly recognize and solve coronary artery perforation. We describe a successfully and conservatively managed type III coronary artery perforation with prolonged balloon inflations, in the absence of covered stents and without compromising the percutaneous coronary intervention result by anticoagulation reversal.


2019 ◽  
Vol 04 (02) ◽  
pp. 110-120
Author(s):  
Tripti Deb ◽  
Jyotsna Maddury ◽  
Prasant Kr. Sahoo

AbstractPercutaneous coronary intervention (PCI) is considered as the standard treatment of obstructive coronary artery disease in indicated patients. Even though PCI gives symptomatic angina improvement, but associated with serious complications like coronary artery perforation (CAP), the incidence is quite low. With the more complex lesions for successful angioplasty, different devices are required, which in turn increase the incidence of CAP in these patients. Here we review the classification, incidence, pathogenesis, clinical sequela, risk factors, predictors, and management of CAP in the current era due to PCI.


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