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Intravascular ultrasound evidence of perivascular trauma during routine percutaneous coronary intervention.
MedLine Citation:
PMID:  24728727     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
We assessed whether intravascular ultrasound (IVUS) can detect evidence of coronary perforation that is not visible by coronary angiography. Approximately 15,000 consecutive percutaneous coronary interventions (PCI) performed with IVUS guidance were reviewed retrospectively, pre- and post-PCI IVUS images were compared, and IVUS findings were compared with coronary angiography and in-hospital outcomes. We detected three distinct patterns that were not present pre-PCI and that were suggestive of perforation or perivascular trauma: perivascular blood speckle in 67 % (51/76), perivascular hematoma in 17 % (13/76), and new echolucent perivascular layer in 16 % (12/76). Angiographic appearance included perforation in 24 % (18/76), dissection in 33 % (25/76), lumen irregularity in 17 % (13/76), new stenosis in 5 % (4/76), and no abnormalities in 21 % (16/76). The site of a break in arterial wall with communication between the lumen and perivascular space could be detected in 61 % (46/76). This extended proximally and distally with equal frequency, but was primarily located within the lesion in 80 % (61/76), although the lumen was rarely compromised. Within 24 h, there were four emergent coronary artery bypass grafting procedures, one repeat PCI, and six periprocedural myocardial infarctions (defined as CK-MB ≥10 times the upper limit of normal), but there were no episodes of cardiac tamponade. Although infrequent, IVUS detected three distinct patterns of post-PCI perivascular trauma suggestive of a perforation that was detected angiographically in only 24 % of cases.
Authors:
Akiko Maehara; Gary S Mintz; Anh B Bui; Augusto D Pichard; Lowell F Satler; Ron Waksman; William O Suddath; Kenneth M Kent; Neil J Weissman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-13
Journal Detail:
Title:  The international journal of cardiovascular imaging     Volume:  -     ISSN:  1875-8312     ISO Abbreviation:  Int J Cardiovasc Imaging     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100969716     Medline TA:  Int J Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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