Abstract
Background
Coronary perforation is a serious complication in percutaneous coronary intervention (PCI), as it can lead to pericardial effusion causing tamponade, often necessitating emergency pericardiocentesis and rarely, cardiac surgery. With increasing treatment of complex coronary lesions, such as chronic total occlusion (CTO), the incidence of coronary perforation is also increasing. Distal wire perforation and collateral vessel perforation can be managed by coil embolization during PCI, which prevented the need of cardiac surgery.
Purpose
To report the short and long-term outcomes of patients with coronary perforation as a complication of PCI managed by coil embolization in our center
Methods
We retrospectively analyzed 66 patients who had coronary perforation treated by coil embolization during PCI from 32007 PCI procedures performed in our center from Oct 2012 to June 2018.
Results
Of sixty-six cases of coronary perforation, twenty-six cases were distal coronary perforation, while 40 cases were collateral perforation. The average coil number used in distal coronary and collateral perforation lesion is 1.8±0.9 and 1.8±1.0, respectively. The maximum number of coil implanted in each patient is 4 in both groups. Two emergency cardiac surgery to seal the perforation was performed after coil embolization in distal coronary perforation and pericardiocentesis, including one distal left circumflex artery perforation and one distal left anterior descending artery perforation. In collateral perforation, one case of CABG was performed due to myocardial ischemia caused by CTO lesion. During a follow-up of 707±476 days, one patient in collateral perforation group had CABG one month later, while no death or myocardial infarction (MI) was detected. Fifty-four (81.2%) cases of perforations occurred while treating chronic total occlusion, and 74.0% of these perforations were located in collateral vessels, mostly epicardial vessels. Thirty-nine CTO cases (72.2%) were revascularized successfully with the aid of coil embolization.
Conclusion
Coil embolization is feasible and effective in treating distal coronary perforation and collateral perforation during PCI procedure. In CTO lesions, coil embolization facilitates the success of revascularization by PCI.
The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter