Coronary artery perforation during percutaneous intervention: incidence and outcome
Coronary artery perforation during percutaneous intervention: incidence and outcome
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DOI：
10.1136/heart.88.5.495
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发表时间：
2002-11-01
期刊：
影响因子：
5.7
通讯作者：
Thomas, MR
中科院分区：
文献类型：
--
作者：
Gunning, MG;Williams, IL;Thomas, MR
目的：检查经皮冠状动脉介入治疗的临床结果，该程序是复杂的血管perforation.Setting：三级转诊center.Methods：6245例接受冠状动脉介入治疗的患者的程序记录进行了审查。在52名患者（0.8%）中，手术因血管穿孔而复杂化，范围从导丝退出到造影剂自由流入心包腔。治疗的大多数病变为复杂病变（37%为B型，59%为C型），52例中有9例（17%）为慢性闭塞。10例患者（19%）接受阿昔单抗治疗。结果：52例患者中有28例（54%）的穿孔是良性的，保守治疗没有发展出血液动力学上的显著后遗症。52例患者中有24例（46%）发生了严重的心包积液，需要引流。在这24例手术中，6例涉及慢性闭塞治疗（25%）。24例患者中有8例（33%）被转诊接受紧急搭桥手术，其中3例死亡。其余16例未转诊手术的患者中，3例死亡。在10例使用阿昔单抗的血管穿孔并发症中，9例（90%）导致心包填塞。最近2血管穿孔成功治疗的部署覆膜stents.Conclusions：冠状动脉穿孔后遗症在介入治疗是罕见的-26 6245（0.4%）。这种并发症见于慢性闭塞的治疗，因此这不是无风险的手术。心包填塞的发生具有很高的死亡率。虽然及时的手术干预可能挽救生命，但覆膜支架使用方面的专业知识可能为这种严重并发症提供有价值的抢救选择。如果发生冠状动脉穿孔且已使用阿昔单抗，则应谨慎。
Objective: To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation.Setting: Tertiary referral centre.Methods: The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%).Results: In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent.Conclusions: Coronary artery perforation with sequelae during intervention is rare-26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not risk-free procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.