Unusual case of coronary perforation which developed delayed cardiac tamponade due to collateral flow from contralateral coronary artery.
ABSTRACT Coronary artery perforation is a rare but catastrophic complication of percutaneous coronary intervention (PCI). PCI for chronic total occlusion (CTO) lesions is associated with lower procedural success rate and higher incidence of complications as compared with non-CTO coronary vessels. Here we report a rare case of a patient who developed coronary perforation during PCI for the CTO lesion and suffered from delayed cardiac tamponade due to collateral flow from the contralateral coronary artery despite complete hemostasis of the perforated site by the covered stent.
SourceAvailable from: onlinelibrary.wiley.com[Show abstract] [Hide abstract]
ABSTRACT: IntroductionCardiac tamponade is a grave but fortunately uncommon complication of percutaneous coronary intervention (PCI). Few studies have specifically addressed angiographic characteristics and outcomes associated with delayed cardiac tamponade after PCI. With the current study we tried to define the incidence of this complication and to characterize the events in order to improve our understanding of the likely mechanisms. Methods/ResultsWe reviewed 23,399 PCIs performed at our institution during an 8-year period (1999–2006) and we present 10 cases of delayed tamponade. A brief description of each case is provided and findings from retrospective review of the coronary angiography, as well as features of PCI complexity are presented. Also, we summarize the procedural characteristics and outcomes. Delayed perforations are rare and possibly preventable. They usually occur after complex interventions and mostly attributed to distal wire perforations. Surgical intervention is needed less often today than before. Successful pericardiocentesis is of paramount importance. Conclusions The potential lethal outcome associated with delayed tamponade emphasizes the importance of taking steps to prevent this complication. First, prevention and, second, prompt treatment should be the goal, with the use of appropriate technique, clinical awareness, and vigilance. © 2013 Wiley Periodicals, Inc.Catheterization and Cardiovascular Interventions 01/2014; 83(1). DOI:10.1002/ccd.25121 · 2.40 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: We describe one case of septal and two cases of epicardial collateral channel perforation during percutaneous coronary intervention by the retrograde approach for chronic total occlusion. After coil embolization of the channel perforation area, additional treatments were required in all three cases to stop bleeding. All three cases required injection of autologous clots, with one case also requiring subsequent injection of fibrin glue.07/2013; 29(1). DOI:10.1007/s12928-013-0198-4
Chinese Medical Sciences Journal 12/2013; 28(4):250-3. DOI:10.1016/S1001-9294(14)60015-8