Clinical Characteristics and Management of Coronary Artery Perforations: A Single-Center 11-Year Experience and Practical Overview

Background: coronary artery perforation (cap) is a potentially lethal complication of percutaneous coronary intervention. we report on the incidence,clinical characteristics,and management of iatrogenic coronary perforations based on an 11-year single-center experience.methods and results: from february 9,2005,through november 20,2016,150 cap cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). mean age of cap patients was 66±11 years,and 62.7% were male. treated lesion type was b2/c in 94.6%,and 31.3% were chronic total occlusions. nonworkhorse guidewires were applied in 74.3%. cap types were ellis type i in 2.9%,ellis type ii in 40.4%,ellis type iii in 54.8%,and ellis type iii cavity spilling in 1.9%. cap treatment was conservative (including prolonged balloon inflation) in 73.3%. covered stents,coiling,and fat embolization were used in 24.0%,0.7%,and 2.0%,respectively. pericardiocentesis for tamponade was required for 72 patients (48.0%),of whom 28 were initially unrecognized. twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. periprocedural myocardial infarction occurred in 34.0%,and in-hospital all-cause mortality was 8.0%. all-cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year.conclusions: cap is a rare complication of percutaneous coronary intervention,but morbidity and mortality are considerable. early recognition and adequate management are of paramount importance. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.