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Acute and long-term outcome after coronary artery perforation during percutaneous coronary interventions

Akut- und Langzeitergebnisse nach Koronarperforation im Rahmen perkutaner Katheterinterventionen

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Zusammenfassung.

Hintergrund:

Die Koronarperforation ist eine seltene, aber schwerwiegende Komplikation perkutaner Katheterinterventionen.

Methoden:

Wir analysierten die Datenbank unseres Herzkatheterlabors hinsichtlich des Auftretens von Koronarperforationen während perkutaner Katheterinterventionen. Unter besonderer Berücksichtigung der Mechanismen der Perforation, des Management der Komplikation und des klinischen Ausgangs wurden die Patientenakten, Katheterberichte und Koronarangiogramme der Patienten mit Koronarperforation analysiert.

Ergebnisse:

Im Zeitraum von 01/1998 bis 12/2003 wurden 6433 Koronarinterventionen durchgeführt. Dabei kam es bei insgesamt 19 (0,3%) Patienten zu einer Koronarperforation (mittleres Alter: 66±8 Jahre, 13 Männer). Bei 12/19 (63%) Patienten trat die Perforation im Rahmen von Rekanalisationen chronischer Totalverschlüsse auf. Bei 18/19 Patienten wurden eine interventionelle Behandlungsstrategie angestrebt: 2 der 19 (11%) Patienten wurden konservativ behandelt (Antagonisieren der Heparin-induzierten Antikoagulation). Längerdauernde Balloninsufflationen im perforierten Gefäßsegment wurde bei 10/19 (53%) Patienten angewandt. Bei 6/19 (32%) Patienten wurde eine Stentimplantation durchgeführt, um die Perforationsstelle abzudichten (5/6 erhielten einen membran-beschichteten Stent-Graft). Drei (16%) Patienten entwickelten eine akute Pericardtamponade und 2 (11%) Patienten wurden einer notfallmäßigen Bypassoperation unterzogen. Insgesamt 2 (11%) Patienten verstarben kurzfristig nach dem Eingriff.

Schlussfolgerung:

Die Koronarperforation ist eine seltene, mit erheblicher Morbidität und Mortalität behaftete Komplikation perkutaner Koronarinterventionen. Eine interventionelle Behandlung ist in den meisten Fällen erfolgreich durchführbar und kann oft einen notfallmäßigen thoraxchirurgischen Eingriff verhindern.

Summary.

Background;

Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions (PCI).

Methods:

We reviewed our database for cases of overt coronary perforation during PCI procedures. Hospital charts, procedural reports, and coronary angiograms of these patients were reviewed, with particular emphasis on mechanisms of perforation, management of the complication, and clinical outcome.

Results:

Between 01/1998 and 12/2003, a total of 19 cases (mean age: 66±8 years, 13 male) of coronary perforation occurred during 6433 PCI procedures performed within this period (incidence: 0.3%). In 12/19 (63%) cases, perforation occurred during recanalisation procedures of chronic total occlusions of coronary arteries. In all but one patient, non-surgical management was attempted: 2 out of 19 (11%) patients were treated conservatively by reversal of heparin anticoagulation. Prolonged balloon inflation at the perforation site was applied in 10/19 (53%) patients. Six (32%) patients received stents (5 of them received covered stentgrafts), 3 (16%) patients developed cardiac tamponade requiring percardiocentesis, and only 2 (11%) patients underwent bailout surgical repair. There were 2 (11%) deaths early after the procedure.

Conclusion:

Coronary perforation during PCI is a rare complication, but is associated with significant morbidity and mortality. In the majority of patients, non-surgical management is both feasible and associated with a high success-rate.

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Authors and Affiliations

  1. Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Germany

    H. Eggebrecht

  2. Westdeutsches Herzzentrum Essen, Klinik für Kardiologie, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

    A. Ritzel,  C. von Birgelen,  A. Schermund,  C. Naber,  D. Böse,  D. Baumgart,  T. Bartel,  M. Haude &  R. Erbel

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  1. H. Eggebrecht
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  2. A. Ritzel
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  3. C. von Birgelen
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  4. A. Schermund
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  5. C. Naber
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  8. T. Bartel
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  9. M. Haude
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  10. R. Erbel
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Correspondence to H. Eggebrecht.

Additional information

Dr. Eggebrecht is recipient of a research grant from the University Duisburg-Essen (IFORES 10+2)

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Eggebrecht, H., Ritzel, A., von Birgelen, C. et al. Acute and long-term outcome after coronary artery perforation during percutaneous coronary interventions. Z Kardiol 93, 791–798 (2004). https://doi.org/10.1007/s00392-004-0123-z

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  • DOI: https://doi.org/10.1007/s00392-004-0123-z

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