Am Heart Hosp J. 2011;9(2):87–9
Lozenge Reference
Original Contribution
Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations— A 10-year Single-center Experience
Preeti Chandra, MD,1 Deepak Thekkoott, MD,4 Robert Frankel, MD, FACC6
Saurav Chatterjee, MD,2 Nishant Koradia, MD,3 Bilal Malik, MD, FACP, FACC, FSCAI,5 and Jacob Shani, MD, FACP, FACC, FSCAI7
Background: Coronary perforation during percutaneous coronary intervention is a rare but dreaded complication. The risk factors, optimal management, and outcome remain obscure. Objectives: 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.
morbidity and mortality.1 C
oronary perforation (CP) during percutaneous coronary intervention (PCI) is a rare complication, but is associated with significant CPs have been reported to
occur in association with coronary wires, balloons, atheroablative devices, stenting, and laser angioplasty.2–6 Vessel punctures can often be treated conservatively with prolonged balloon inflation,7
coil embolization,8,9 polytetrafluoroethylene (PTFE)-covered stents,10 or while
vessel ruptures with cardiac tamponade and hemodynamic compromise often necessitate emergency surgery. Prior studies have determined risk factors that place patients at higher risk of CP, including increasing age, female gender,
heavy calcification, target lesions in the left circumflex and right coronary arteries, long target lesions (>10 mm), and eccentric lesions.6,11,12
The objectives of the study
were to determine the predisposing factors, optimal management, and possible preventive strategies in all subjects developing perforations during PCI in a single center between 2000 and 2009 and also to see if arterial inflammation, by causing possible increased friability of vessel walls, conferred a higher risk of perforations.
Methods
All subjects developing perforations between 2000 and 2009 were retrospectively looked at using chart reviews
• 1. Fellow, Cardiology; 2. Resident, Internal Medicine; 3. Fellow; 4. Fellow; 5. Attending; 6. Director of the Cardiac Catheterization Lab; 7. Director of the Cardiac Institute, Division of Cardiology, Dept of Internal Medicine, Maimonides Medical Center.
• Disclosure: The authors have no conflicts of interest to declare.
• Correspondence: Saurav Chatterjee, MD, Resident, Internal Medicine, Maimonides Medical Center, 864 49th Street, Apt C11, Brooklyn, NY 11220. E:
sauravchatterjeemd@gmail.com
Winter 2011 Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations 87
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