Document Detail


The changing pattern of coronary perforation during percutaneous coronary intervention in the new device era.
MedLine Citation:
PMID:  15155997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report the incidence, management and clinical outcome of coronary perforations in 39 of 12,658 patients (0.3%) undergoing percutaneous coronary intervention (PCI). Coronary perforation occurred more frequently with debulking techniques than with non-debulking (percutaneous transluminal coronary angioplasty and stent) techniques (1% versus 0.2%; p<0.001). There were 8 type I (20.5%), 15 type II (38.5%) and 16 type III (41%) perforations. Importantly, fifty-one percent of the coronary perforations were guide-wire related. Major adverse clinical outcomes occurred more frequently in patients who experienced type III perforations. Conventional strategies to treat perforations (i.e., prolonged balloon inflation and reverse of the anticoagulated state) were used. There was one death (2.6%), two emergency surgeries (5.2%) and no Q-wave myocardial infarctions. Pericardial effusion occurred in 18 of 39 patients (46.2%), with cardiac tamponade occurring in 7 patients. In the current device era, the incidence of coronary perforation remains low; it occurs more frequently with debulking devices and is often a consequence of guidewire injury. Its outcome is not affected with the use of IIb/IIIa antagonists. Treatment of coronary perforation requires early detection, angiographic classification, immediate occlusion of coronary vessel extravasation and relief of hemodynamic compromise, reversal of heparin anticoagulation, platelet transfusion in those patients treated with abciximab and cover stents.
Authors:
Christian F Witzke; Francisco Martin-Herrero; Sarah C Clarke; Eugene Pomerantzev; Igor F Palacios
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  16     ISSN:  1042-3931     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-24     Completed Date:  2004-07-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-301     Citation Subset:  IM    
Affiliation:
Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*,  methods
Atherectomy, Coronary / adverse effects
Coronary Vessels / injuries*
Female
Humans
Male
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Risk Factors
Stents
Wounds, Penetrating / epidemiology,  etiology*,  therapy
Chemical
Reg. No./Substance:
0/Platelet Glycoprotein GPIIb-IIIa Complex
Comments/Corrections
Comment In:
J Invasive Cardiol. 2004 Jun;16(6):302-3   [PMID:  15155998 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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