Skip to main content
SpringerLink
Log in
Book cover

Textbook of Catheter-Based Cardiovascular Interventions pp 1017–1037Cite as

Complications of Coronary Intervention: Coronary Wall Dissection and Perforation

  • Chapter
  • First Online:

  • 520 Accesses

Abstract

Coronary dissection and perforation are the most common and most feared complications during coronary interventions, both of which can lead to catastrophic consequences if not recognized early and managed properly. However, despite their high associated morbidities and mortalities, these complications can be appropriately managed and effectively prevented if their etiologies, risks factors, and treatments are thoroughly understood and practiced. This chapter discusses these two important complications, with special emphasis on approaches to their management.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Grüntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979;301(2):61–8.

    Article  PubMed  Google Scholar 

  2. Seshadri N, Whitlow PL, Acharya N, Houghtaling P, Blackstone EH, Ellis SG. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation. 2002;106:2346–50.

    Article  PubMed  Google Scholar 

  3. Bruce FW, Charles MO, John DS, Cass AP, James VT, Thomas P. Anatomy, histology, and pathology of coronary arteries: a review relevant to new interventional and imaging techniques part I. Clin Cardiol. 1992;15:451–7.

    Article  Google Scholar 

  4. Sharma SK, Israel DH, Kamean JL, Bodian CA, Ambrose JA. Clinical, angiographic, and procedural determinants of major and minor coronary dissection during angioplasty. American Heart J. 1993;126(1):39–47.

    Article  CAS  Google Scholar 

  5. Lincoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ. Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol. 1992;19(5):926–35.

    Article  CAS  PubMed  Google Scholar 

  6. NHBLI Coronary artery angiographic changes after PTCA: Manual of Operations NHBLI PTCA Registry 1985–6:9.

    Google Scholar 

  7. Ferguson JJ, Barasch E, Wilson JM, Strony J, Wolfe MW, Schweiger MJ, Leya F, Bonan R, Isner JM, Roubin GS. The relation of clinical outcome to dissection and thrombus formation during coronary angioplasty. Heparin registry investigators. J Invasive Cardiol. 1995;7:2–10.

    PubMed  CAS  Google Scholar 

  8. Klein LW. Coronary complications of percutaneous coronary intervention: a practical approach to the management of abrupt closure. Cathet Cardiovasc Intervent. 2005;64:395–401.

    Article  Google Scholar 

  9. Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol. 1991;68(5):467–71.

    Article  CAS  PubMed  Google Scholar 

  10. Hermans WR, Rensing BJ, Foley DP, Deckers JW, Rutsch W, Emanuelsson H, Danchin N, Wijns W, Chappuis F, Serruys PW. Therapeutic dissection after successful coronary balloon angioplasty: no influence on restenosis or on clinical outcome in 693 patients. The MERCATOR study group. J Am Coll Cardiol. 1992;20(4):767–80.

    Article  CAS  PubMed  Google Scholar 

  11. Bansal A, Choksi NA, Levine AB, et al. Determinants of arterial dissection during PTCA: lesion type versus inflation rate. J Am Coll Cardiol. 1989;12:229A.

    Google Scholar 

  12. Zidi M, Nallet O, Esteve JB, Michaud P, Cattan S. Extensive iatrogenic coronary dissection during coronary angioplasty: a series of 19 consecutive patients. Ann Cardiol Angeiol (Paris). 2010;59(5):306–10.

    Article  CAS  Google Scholar 

  13. Rogers JH, Lasala JM. Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol. 2004;16(9):493–9.

    PubMed  Google Scholar 

  14. Chamie D, Bezerra HG, Attizzani GF, Yamamoto H, Kanaya T, Stefano GT, Fujino Y, Mehanna E, Wang W, Abdul-Aziz A, Dias M, Simon DI, Costa MA. Incidence, predictors, morphological characteristics, and clinical outcomes of stent edge dissections detected by optical coherence tomography. J Am Coll Cardiol Intv. 2013;6(8):800–13.

    Article  Google Scholar 

  15. Biondi-Zoccai GG, Agostoni P, Sangiorgi GM, Airoldi F, Cosgrave J, Chieffo A, Barbagallo R, Tamburino C, Vittori G, Falchetti E, Margheri M, Briguori C, Remigi E, Iakovou I, Colombo A. Incidence, predictors, and outcome of coronary dissections left untreated after drug-eluting stent implantation. Eur Heart J. 2006;27(5):540–6.

    Article  PubMed  Google Scholar 

  16. Shorrock D, Michael TT, Patel V, Kotsia A, Rangan BV, Abdullah SA, Grodin JM, Banerjee A, Brilakis ES. Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systemic review oft he literature. Catheter Cardiovasc Interv. 2014;84(4):670–5.

    Article  PubMed  Google Scholar 

  17. Smith EJ, Di Mario C, Spratt JC, Hanratty CG, de Silva R, Lindsay AC, Grantham JA. Subintimal TRAnscatheter withdrawal of hematomas compressing the distal true lumen: a novel technique to facilitate distal reentry during recanalization of chronic total occlusion. J Invasive Cardiol. 2015;27(1):E1–4.

    PubMed  Google Scholar 

  18. Carlino M, Al-Lamee R, Ielasi A, Godino C, Latib A, Chieffo A, Colombo A. Treatment of iatrogenic occlusive coronary dissection: a novel approach. EuroIntervention. 2011;7(1):106–11.

    Article  PubMed  Google Scholar 

  19. Prati F, Di Vito L, Biondi-Zoccai G, Occhipinti M, La Manna A, Tamburino C, Burzotta F, Trani C, Porto I, Ramazzotti IF, Manzoli A, Materia L, Cremonesi A, Albertucci M. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l’Infarto-optimisation of percutaneous coronary intervention (CLI-OPCI) study. EuroIntervention. 2012;8:823–9.

    Article  PubMed  Google Scholar 

  20. Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seller C, Meier B, Windecker S, Carrel T, Wenaweser P, Cook S. Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up. Am Heart J. 2010;159(6):1147–53.

    Article  PubMed  Google Scholar 

  21. Dunning DW, Kahn JK, Hawkins ET. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv. 2000;51:387–93.

    Article  CAS  PubMed  Google Scholar 

  22. Boyle AJ, Chan M, Dib J. Catheter-induced coronary artery dissection: risk factors, prevention and management. J Invasive Cardiol. 2006;18:500–3.

    PubMed  Google Scholar 

  23. Nunez-Gil IJ, Bautista D, Cerrato E, Salinas P, Varbella F, Omede P, Ugo F, Ielasi A, Giammaria M, Moreno R, Perez-Vizcayno MJ, Escaned J, De Agustin JA, Feltes G, Macaya C, Fernandez-Ortiz A. Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or interventional coronary procedures. Circulation. 2015;131(24):2114–9.

    Article  PubMed  Google Scholar 

  24. Rylski B, Hoffmann I, Beyersdorf F, Suedkamp M, Siepe M, Nitsch B, Blettner M, Borger MA, Weigang E. Iatrogenic acute aortic dissection type a: insight from the German registry for acute aortic dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2013;44:353–9.

    Article  PubMed  Google Scholar 

  25. Gomez-Moreno S, Sabate M, Jimenez-Quevedo P, Vazquez P, Alfonso F, Angiolilo DJ, Hernandez-Antolin R, Moreno R, Banuelos C, Escaned J, Macaya C. Iatrogenic dissection of the ascending aorta following heart catheterisation: incidence, management and outcome. EuroIntervention. 2006;2(2):197–202.

    PubMed  Google Scholar 

  26. Shimony A, Joseph L, Mottillo S, Eisenberg MJ. Coronary artery perforation during percutaneous coronary intervention: a systemic review and meta-analysis. Can J Cardiol. 2011;27(6):843–50.

    Article  PubMed  Google Scholar 

  27. Ajluni SC, Glazier S, Blankenship L, O’Neil WW, Safian RD. Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. Catheter Cardiovasc Diagn. 1994;32:206–12.

    Article  CAS  Google Scholar 

  28. Fukutomi T, Suzuki T, Popma JJ, Hosokawa H, Yokoya K, Inada T, Hayase M, Kondo H, Ito S, Suzuki S, Itoh M. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. Circ J. 2002;66(4):349–56.

    Article  PubMed  Google Scholar 

  29. Kiernan TJ, Yan BP, Ruggiero N, Eisenberg JD, Bernal J, Cubeddu RJ, Witzke C, Don C, Cruz-Gonzalez I, Rosenfield K, Pomersantev E, Palacios I. Coronary artery perforations in the contemporary interventional era. J Interv Cardiol. 2009;22(4):350–3.

    Article  CAS  PubMed  Google Scholar 

  30. Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Mussardo M, Arioli F, Carlino M, Montorfano M, Chieffo A, Colombo A. Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation. JACC Cardiovascular Interv. 2011;4:87–95.

    Article  Google Scholar 

  31. Witzke CF, Martin-Herrero F, Clarke SC, Pomerantzev E, Palacios IF. The changing pattern of coronary perforation during percutaneous coronary intervention in the new device era. J Invasive Cardiol. 2004;16(6):257–301.

    PubMed  Google Scholar 

  32. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, Cowley MJ, Raymond RE, Safian RD, Whitlow PL. Increased coronary perforation in the new device era. Incidence, classification, management and outcome. Circulation. 1994;90:2725–30.

    Article  CAS  PubMed  Google Scholar 

  33. Stankovic G, Orlic D, Corvaja N, et al. Incidence, predictors, in-hospital, and late outcomes of coronary perforation. Am J Cardiol. 2004;93:213–6.

    Article  PubMed  Google Scholar 

  34. Gruberg L, Pinnow E, Flood R, Bonnet Y, Tebeica M, Waksman R, Satler LF, Pichard AD, Kent KM, Leon MB, Lindsay J Jr. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2000;86(6):680–2. A688

    Article  CAS  PubMed  Google Scholar 

  35. Gunning MG, Williams IL, Jewitt DE, Shah AM, Wainwright RJ, Thomas MR. Coronary artery perforation during percutaneous intervention: incidence and outcome. Heart. 2002;88:495–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Ramana RK, Arab D, Joyal D, et al. Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era. J Invasive Cardiol. 2005;17:603–5.

    PubMed  Google Scholar 

  37. Cohen BM, Weber VJ, Reisman M, Casale A, Dorros G. Coronary perforation complicating rotational ablation: the U.S. multicenter experience. Catheter Cardiovasc Diagn. 1996;3:55–9.

    Google Scholar 

  38. Javaid A, Buch AN, Satler LF, et al. Management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2006;98:911–4.

    Article  PubMed  Google Scholar 

  39. Chowdhury MA, Sheikh MA. Coronary bypass graft perforation during percutaneous intervention. Cirdiovasc Revasc Med. 2016;17(1):48–53.

    Article  Google Scholar 

  40. Shimony A, Zahger D, Van Straten M, Shalev A, Gilutz H, Ilia R, Cafri C. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2009;104(12):1674–7.

    Article  PubMed  Google Scholar 

  41. Dippel EJ, Kereiakes DJ, Tramuta DA, Broderick TM, Shimshak TM, Roth EM, Hatterner CR, Runyon JP, Whang DD, Schneider JF, Abbottsmith CW. Coronary perforation during percutaneous coronary intervention in the ear of abciximab platelet glycoprotein IIb/IIIa blockade: an algorithm for percutaneous management. Catheter Cardiovasc Interv. 2001;52:279–86.

    Article  CAS  PubMed  Google Scholar 

  42. Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiya Y, Cristea E, Collins M, Mehran R, Dangas GD, Moses JW, Leon MB, Stone GW. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006;98(3):370–4.

    Article  CAS  PubMed  Google Scholar 

  43. Park SH, Rha SW, Cho AR, Lee HG, Choi CU, Oh DJ. Successful management of iatrogenic coronary arteriovenous fistula developed during chronic total occlusion intervention. J Cardiol Cases. 2012;6(4):e96–9.

    Article  Google Scholar 

  44. Kini AS, Rafael OC, Sarkar K, et al. Changing outcomes and treatment strategies for wire induced coronary perforations in the era of bivalirudin use. Catheter Cardiovasc Interv. 2009;74:700–7.

    Article  PubMed  Google Scholar 

  45. Muller O, Windecker S, Cuisset T, Fajadet J, Mason M, Zuffi A, Doganov A, Eeckhout E. Management of two major complications in the cardiac catheterization laboratory: the no-reflow phenomenon and coronary perforations. Eur Secur. 2008;4:181–3.

    Google Scholar 

  46. Ben-Gal Y, Weisz G, Collins MB, et al. Dual catheter technique for the treatment of severe coronary artery perforations. Catheter Cardiovasc Interv. 2010;75:708–12.

    Article  PubMed  Google Scholar 

  47. Young G, Yonekawa KE, Nakagawa PA, Blain RC, Lovejoy AE, Nugent DJ. Recombinatnt activated factor VII effectively reverses the anticoagulant effects of heparin, enoxaparin, Fondaparinux, argatroban, and bivalinrudin ex vivo as measured using thromboelastography. Blood Coagul Fibrinolysis. 2007;18:547–53.

    Article  CAS  PubMed  Google Scholar 

  48. Aslam MS, Messersmith RN, Gilbert J, Lakier JB. Successful management of coronary artery perforation with helical platinum microcoil embolization. Catheter Cardiovasc Interv. 2000;51(3):320–2.

    Article  CAS  PubMed  Google Scholar 

  49. Dixon SR, Webster MW, Ormiston JA, Wattie WJ, Hammett CJ. Gelfoam embolization of a distal coronary artery guidewire perforation. Catheter Cardiovasc Interv. 2000;49(2):214–7.

    Article  CAS  PubMed  Google Scholar 

  50. Tanaka S, Nishigaki K, Ojio S, Yasuda S, Okubo M, Yamaki T, Kubota T, Takasugi N, Ishihara Y, Kawasaki M, Minatoguchi S. Transcatheter embolization by autologous blood clot is useful management for small side branch perforation due to percutaneous coronary intervention guidewire. J Cardiol. 2008;52(3):285–9.

    Article  PubMed  Google Scholar 

  51. Yoo BS, Yoon J, Lee SH, Kim JY, Lee HH, Ko JY, Lee BK, Hwang SO, Choe KH. Guidewire-induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol form. Catheter Cardiovasc Interv. 2001;52(2):231–4.

    Article  CAS  PubMed  Google Scholar 

  52. Fischell TA, Korban EH, Lauer MA. Successful treatment of distal coronary guidewire-induced perforation with balloon catheter delivery of intracoronary thrombin. Catheter Cardiovasc Interv. 2003;58(3):370–4.

    Article  PubMed  Google Scholar 

  53. Oda H, Oda M, Makiyama Y, Kashimura T, Takahashi K, Miida T, Higuma N. Guidewire-induced coronary artery perforation treated with transcatheter delivery of subcutaneous tissue. Catheter Cardiovasc Interv. 2005;66(3):369–74.

    Article  PubMed  Google Scholar 

  54. Yeo KK, Rogers JH, Laird JR. Use of stent grafts and coils in vessel rupture and perforation. J Interv Cardiol. 2008;21(1):86–99.

    Article  PubMed  Google Scholar 

  55. Ishihara S, Tabata S, Inoue T. A novel method to bail out coronary perforation: micro-catheter distal perfusion technique. Catheter Cardiovasc Interv. 2015 Sep;86(3):417–21.

    Article  PubMed  Google Scholar 

  56. Komatsu I, Hirano K, Takimura H, Araki M, Yamawaki M, Nakano M, Ishimori H, Ito Y, Tsukahara R, Muramatsu T. A case of coronary artery perforation with successful hemostasis using over-the-wire balloon and autologous blood perfusion. Cardiovasc Interv Ther. 2013;28(2):197–201.

    Article  PubMed  Google Scholar 

  57. Sera F, Awata M, Uematsu M, Kotani JI, Nanto S, Nagata S. Optimal stent-sizing with intravascular ultrasound contributes to complete neointimal coverage after sirolimus-eluting stent implantation assessed by angioscopy. J Am Coll Cardiol Intv. 2009;2(10):989–94.

    Article  Google Scholar 

  58. Carlino M, et al. Treatment of iatrogenic occlusive dissections: a novel approach. EuroIntervention. 2011;6:106–11.

    Article  Google Scholar 

  59. Muller O, et al. Management of two major complications in the cardiac catheterization laboratory: the no-reflow phenomenon and coronary perforations. EuroIntervention. 2008;4:181–3.

    Article  PubMed  Google Scholar 

  60. Nguyen T, Gibson M, Bailey SR. Practical handbook of advanced interventional cardiology: tips and tricks. 4th ed. Chichester: Wiley; 2013.

    Google Scholar 

  61. Harries I, et al. Tools & techniques – clinical: management of coronary perforation. EuroIntervention. 2014;10(5):646–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

I would like to express my heartfelt thanks to my wife Crystal Mui and my family for their generous indulgence, unconditional support, and unlimited patience throughout my life.

Author information

Authors and Affiliations

  1. Queen Elizabeth Hospital, Division of Cardiology, Department of Medicine, Hong Kong, China

    Kevin Kwok, Michael Lee & Kam Tim Chan

  2. Tuen Mun Hospital, Division of Cardiology, Department of Medicine, Hong Kong, China

    Lawrence Yeung

  3. Centre Hospitalier Universitaire Vaudois (CHUV), Service de Cardiologie, Lausanne, Switzerland

    Catalina Trana, Brahim Harbaoui, Christan Roguelov, Olivier Muller, Daniel Wagner & Eric Eeckhout

Authors
  1. Kevin Kwok
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence Yeung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catalina Trana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brahim Harbaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christan Roguelov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier Muller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kam Tim Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eric Eeckhout
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin Kwok .

Editor information

Editors and Affiliations

  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kwok, K. et al. (2018). Complications of Coronary Intervention: Coronary Wall Dissection and Perforation. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_61

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55994-0_61

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55993-3

  • Online ISBN: 978-3-319-55994-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation