Korean Circ J.  2012 May;42(5):352-354. 10.4070/kcj.2012.42.5.352.

Fatal Delayed Coronary Artery Perforation After Coronary Stent Implantation

• Kim SH
• Moon JY
• Sung JH
• Kim IJ
• Lim SW
• Cha DH
• Cho SY

• KMID: 2028766
• DOI: http://doi.org/10.4070/kcj.2012.42.5.352

Abstract

Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

Keyword

Cardiac tamponade; Complications; Percutaneous transluminal coronary angioplasty; Drug-eluting stent

MeSH Terms

Angioplasty, Balloon, Coronary
Cardiac Tamponade
Coronary Vessels
Drainage
Drug-Eluting Stents
Heart Arrest
Stents

Figure

• 

  Fig. 1 Coronary angiogram for pecutaneous coronary intervention for critical stenosis of left. Circumflex artery. A: coronary angiogram showed critical stenosis of left circumflex artery (arrow). B: after stenting, angiogram showed mild residual stenosis in proximal stented lesion and intravascular ultrasound showed incomplete expansions. C: final angiogram showed no residual lesion and final intravascular ultrasound images revealed improved expansion and good apposition of the stent.

• 

  Fig. 2 Coronary angiogram after cardiovascular resuscitation due to sudden cardiac arrest in general ward. A: angiogram showed type III coronary perforation with bleeding at the previous stent implantation site (arrow). B: before inflation, first Jo graft stent was placed for the active bleeding site. C: after stenting of two graft stents, the final angiogram during cardiovascular resuscitation showed no additional bleeding.

Reference

1. Ellis SG, Ajluni S, Arnold AZ, et al. Increased coronary perforation in the new device era: incidence, classification, management, and outcome. Circulation. 1994. 90:2725–2730.

2. Gunning MG, Williams IL, Jewitt DE, Shah AM, Wainwright RJ, Thomas MR. Coronary artery perforation during percutaneous intervention: incidence and outcome. Heart. 2002. 88:495–498.

3. Gruberg L, Pinnow E, Flood R, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2000. 86:680–682.

4. Shimony A, Zahger D, Van Straten M, et al. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2009. 104:1674–1677.

5. Von Sohsten R, Kopistansky C, Cohen M, Kussmaul WG 3rd. Cardiac tamponade in the "new device" era: evaluation of 6999 consecutive percutaneous coronary interventions. Am Heart J. 2000. 140:279–283.

6. Fasseas P, Orford JL, Panetta CJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J. 2004. 147:140–145.

7. Fukutomi T, Suzuki T, Popma JJ, et al. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. Circ J. 2002. 66:349–356.

8. 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. 17:603–605.