Abstract
Reported is a technique that was used to treat a distal left anterior descending (LAD) perforation in a patient undergoing percutaneous coronary intervention (PCI) for distal LAD total occlusion. The perforation was successfully treated by re-occluding the LAD with implantation of a polytetrafluoroethylene (PTFE)-covered stent in a diagonal branch extending to the LAD (side branch graft stenting technique) delivered using the dual catheter technique. This approach is proposed as an alternative bail-out technique that can be used in cases where other treatment options for coronary perforation are either unavailable or potentially not successful, especially during PCI for total occlusions, where the disadvantage of main vessel occlusion is already present.
Zusammenfassung
Wir berichten über ein Verfahren zur Behandlung einer Perforation des distalen Ramus interventricularis anterior (RIVA) bei einem Patienten, der wegen einer vollständigen Okklusion des distalen RIVA einer perkutanen Koronarintervention (PCI) unterzogen wurde. Die Perforation wurde erfolgreich behandelt, indem der RIVA mit einem Polytetrafluoroethylen(PTFE)-beschichteten Stent erneut verschlossen wurde. Der Stent wurde unter Anwendung des Dualkatheterverfahrens in einen diagonalen Ast eingeführt und erstreckte sich von dort in den RIVA (Side-branch-graft-stenting-Verfahren). Wir schlagen diesen Ansatz als Alternative für Notfälle vor, in denen andere Verfahren zur Therapie einer Koronarperforation entweder nicht verfügbar sind oder keinen Erfolg versprechen, insbesondere im Rahmen einer PCI bei vollständiger Okklusion, wenn sich der Verschluss eines Hauptgefäßes bereits nachteilig auswirkt.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ellis SG, Ajluni S, Arnold AZ et al (1994) Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation 90:2725–2730
Ajluni SC, Glazier S, Blankenship L et al (1994) Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. Cathet Cardiovasc Diagn 32:206–212
Gruberg L, Pinnow E, Flood R et al (2000) Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 86:680–682, A8
Fejka M, Dixon SR, Safian RD et al (2002) Diagnosis, management, and clinical outcome of cardiac tamponade complicating percutaneous coronary intervention. Am J Cardiol 90:1183–1186
Fasseas P, Orford JL, Panetta CJ et al (2004) Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J 147:140–145
Briguori C, Nishida T, Anzuini A et al (2000) Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures. Circulation 102:3028–3031
Lansky AJ, Yang Y, Khan Y et al (2006) Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol 98:370–374
Ben-Gal Y, Weisz G, Collins MB et al (2010) Dual catheter technique for the treatment of severe coronary artery perforations. Catheter Cardiovasc Interv 75:708–712
Assali AR, Moustapha A, Sdringola S et al (2000) Successful treatment of coronary artery perforation in an abciximab-treated patient by microcoil embolization. Catheter Cardiovasc Interv 51:487–489
Dippel EJ, Kereiakes DJ, Tramuta DA et al (2001) Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: an algorithm for percutaneous management. Catheter Cardiovasc Interv 52:279–286
Kini AS, Rafael OC, Sarkar K et al (2009) Changing outcomes and treatment strategies for wire induced coronary perforations in the era of bivalirudin use. Catheter Cardiovasc Interv 74:700–777
Holmes DR Jr, Reeder GS, Ghazzal ZM et al (1994) Coronary perforation after excimer laser coronary angioplasty: the excimer laser coronary angioplasty registry experience. J Am Coll Cardiol 23:330–335
Bittl JA, Ryan TJ Jr, Keaney JF Jr et al (1993) Coronary artery perforation during excimer laser coronary angioplasty. The percutaneous excimer laser coronary angioplasty registry. J Am Coll Cardiol 21:1158–1165
Wong CM, Kwong Mak GY, Chung DT (1998) Distal coronary artery perforation resulting from the use of hydrophilic coated guidewire in tortuous vessels. Cathet Cardiovasc Diagn 44:93–96
Silver KH, Bauman WB, Berkovitz KE (2003) Dual-catheter covered stenting: a novel approach to the treatment of large coronary artery perforations. J Invasive Cardiol 15:348–350
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ziakas, A., Economou, F., Feloukidis, C. et al. Left anterior descending artery perforation treated with graft stenting combining dual catheter and side branch graft stenting techniques. Herz 37, 913–916 (2012). https://doi.org/10.1007/s00059-012-3645-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-012-3645-6
Keywords
- Left anterior descending perforation
- Aorta, thoracic
- Percutaneous coronary intervention
- Dual catheter technique
- Coronary occlusion