Novel approach to coronary artery perforation repair

Catheter Cardiovasc Interv. 2019 Feb 1;93(2):E98-E100. doi: 10.1002/ccd.27849. Epub 2018 Sep 9.

Abstract

Coronary artery perforation (CAP) during percutaneous coronary intervention is a rare but serious complication. Treatment options of CAP include prolonged balloon inflation, covered stent, and coil embolization. Although most cases of CAP can be treated with prolonged balloon inflation, some cases, especially Ellis grade III CAP require covered stents or coiling. Covered stents may require a large bore guide catheter and have a high rate of restenosis, which can be a limiting factor in patients with severe peripheral arterial disease. Coil embolization is generally used in distal CAP because coiling in the proximal vessels results in a large territory of infarction. We present a case of an Ellis grade III CAP during rotational atherectomy successfully treated with a novel coiling technique whereby the thrombogenic coil extends through the perforation outside of the vessel, and the intraarterial portion of the coil is excluded from the lumen by drug-eluting stent placement over the proximal portion of the coil.

Keywords: complication; coronary artery perforation; coronary repair; percutaneous coronary intervention.

Publication types

  • Case Reports

MeSH terms

  • Atherectomy, Coronary / adverse effects*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy*
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / injuries*
  • Drug-Eluting Stents
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods*
  • Heart Injuries / diagnostic imaging
  • Heart Injuries / etiology
  • Heart Injuries / therapy*
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / instrumentation
  • Treatment Outcome
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / therapy*
  • Vascular System Injuries / diagnostic imaging
  • Vascular System Injuries / etiology
  • Vascular System Injuries / therapy*