Coronary artery perforation complicating percutaneous coronary intervention

Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.