PCI Complications: Vessel Perforation
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Definition and Incidence
Coronary perforations are uncommon (< 1%) complications of percutaneous coronary intervention (PCI) and are associated with significant morbidity and mortality rates. [1] [1] [1] [1] [1] Coronary perforations are infrequent in patients undergoing balloon angioplasty (0.1%) compared with patients undergoing atheroablative therapy (1.3%; P< 0.001) [1] [1] Perforation due to coronary guidewires may present late after the procedure.
The prognosis following coronary perforation depends on the extent of extravastion into the pericardium [1].
Classification
This classification scheme has been developed based on angiographic appearance of the perforation
- Type I perforations including an extraluminal crater without extravasation
- Type II perforations containing pericardial or myocardial blushing
- Type III perforations having a ≥ 1 mm diameter with contrast streaming; and cavity spilling [1].
Coronary Artery Perforation
RCA perforation during PCI (This video file is copylefted).
- Class I perforations were associated with no deaths and cardiac tamponade in 8% of patients.
- Class II perforations were associated with no deaths and cardiac tamponade in 13% of cases
- Class III perforations were associated with death in 19% and cardiac tamponade in 63% of patients [1].
Treatment
Initial management strategies include:
- Prolonged balloon inflation: For this reason it is often wise for a cardiac catheterization laboratory to have perfusion balloons in a range of sizes available.
- Reversal of anticoagulation: This would included administration of protamine to reverse heparin and administration of platelets if abciximab has been administered.
- In refractory cases, polytetrafluoroethylene covered stents (stent grafts) can be used to seal the perforation [1] [1] .
Approx. 1/3 of cases of PCI-associated coronary artery perforation require emergent cardiac surgery
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
