Key result
Coronary artery perforation during PCI is linked to a ~10% in-hospital mortality rate.
Why the study?
Distal coronary artery perforation caused by guidewires during PTCA has become more difficult to manage and potentially lethal in the era of potent glycoprotein IIb/IIIa inhibitors.
Cohort (n=51)
No
High mortality with rare perforations warrants vigilance in PCI; retrospective data leaves open optimal prevention and bailout strategies.
Distal coronary artery perforation with a coronary guidewire is a relatively rare but potentially fatal complication during PTCA. Historically, these types of perforations have been easy to control with reversal of heparin anticoagulation combined with prolonged distal balloon inflation. In the modern era, with widespread use of potent glycoprotein IIb/IIIa inhibitors, this type of distal wire perforation has become more difficult to manage and potentially lethal. In this article, we report two cases of guidewire-related distal coronary artery perforation, successfully treated using a new technique using localized, distal intracoronary thrombin injection. During prolonged low-pressure balloon inflation, a small dose of thrombin was injected just proximal to the wire perforation site via the lumen of a coronary balloon catheter. This approach appears to be a relatively rapid and effective way to control this troublesome complication.
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Fischell et al. (2003) conducted a cohort in Coronary artery perforation during percutaneous coronary intervention (n=51). Coronary artery perforation during PCI was evaluated on In-hospital mortality. In a retrospective analysis of 40,696 patients undergoing percutaneous coronary intervention, coronary artery perforation occurred in 0.13% (51 patients) and was associated with a 10% in-hospital mortality rate.
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