Coil embolization for successful treatment of perforation of chronically occluded proximal coronary artery.

We describe a case of a coronary artery perforation involving the proximal right coronary artery that was successfully managed by percutaneous coil embolization. In the setting of a chronic coronary artery occlusion, this demonstrates the successful use of thrombogenic platinum alloy coils for a large proximal vessel perforation which has not been described previously.     

Coronary artery perforation repair using microcoil embolization

An 82-year-old woman undergoing percutaneous transluminal coronary angioplasty experienced perforation of the terminal portion of the left anterior descending coronary artery caused by guidewire trauma. The coronary artery perforation was successfully closed using a vascular occlusion system consisting of individual thrombogenic coils delivered to the site. Coronary artery perforation (CAP) during percutaneous transluminal coronary angioplasty (PTCA) has been reported to occur in less than 1% of cases. The incidence seems to be higher with the new interventional devices, e.g., DCA, TEC, and laser CAP may result in pericardial hemorrhage and cardiac tamponade or a coronary artery fistula to either the left or right ventricle. The management of CAP may include prolonged balloon inflations, reversal of anticoagulation, pericardiocentesis, and emergency surgery. Proximal perforations sometimes can be managed with vein covered stents. We describe another option in the treatment of distal CAP using a vascular occlusion system. Cathet. Cardiovasc. Diagn. 43:474–476, 1998. © 1998 Wiley-Liss, Inc.     

Percutaneous closure of coronary pulmonary arterial fistula using catheterization laboratory trash.

We report a case of coronary pulmonary arterial fistula that was successfully occluded by packing the fistula with thrombogenic floppy tips of used percutaneous transluminal coronary angioplasty guidewires instead of conventional steel coils.     

Successful treatment of coronary artery perforation in an abciximab-treated patient by microcoil embolization.

We describe a case of type 2 coronary artery perforation in a 73-year-old man undergoing coronary artery rotablation and stenting with abciximab therapy. The coronary artery perforation was successfully treated by coil embolization with Trufill pushable coils made from platinum alloy and synthetic fibers to promote maximum thrombogenicity.     

Cardiac perforation complicated by cardiac tamponade and sealed with metallic coils

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perforation in a distal branch of the right coronary artery caused by the coronary guidewire tip, and complicated by acute cardiac tamponade. Blood extravasation to the pericardium was stopped by releasing two metallic coils into the distal vessel, thereby avoiding the need for emergent cardiac surgery.     

Recurrent cardiac tamponade following unusual micro leak after successful closure of the primary leak

Although uncommon, coronary artery perforation is one of the most dreadful complications of percutaneous coronary intervention, which requires prompt, aggressive, and effective management. Perforations induced by coronary guidewires are usually located in the distal part of a coronary artery and commonly managed with embolization. This is an unusual case report of guidewire-induced coronary perforation with recurrent cardiac tamponade, which was managed successfully by coil embolization of both ipsilateral and contralateral coronary arteries via transradial approach.     

Successful management of coronary artery perforation with helical platinum microcoil embolization.

A case of small coronary artery perforation during coronary intervention is presented. Continued leakage occurred despite prolonged intracoronary balloon inflation, in part probably related to the use of glycoprotein (GP) IIB/IIIA inhibitors. It was successfully managed by microcoil embolization without any sequel, helping avoid surgery in a high-risk patient. Cathet. Cardiovasc. Intervent. 51:320-322, 2000.     

Successful embolization of iatrogenic ruptured coronary artery using Onyx: A new technique

Abstract

Iatrogenic perforation of coronary artery is rare during percutaneous coronary intervention (PCI); however the complications are life-threatening. Patients in this clinical setting may be treated either by stent placement, closure of the perforation with fibrin glue or coils, or with emergency bypass surgery. Onyx, a new material that has been used successfully in cerebral arteries, represents a new and safe alternative. The advantage of Onyx is that it is easily injected through a microcatheter and it allows for a longer injection time having also the ability to reach difficult anatomical locations. We present the first case of successful embolization of a right coronary artery perforation during coronary angio graphy using Onyx.     

Successful treatment of an excimer laser-associated coronary artery perforation with the Stack perfusion catheter

A 64-year-old woman underwent excimer laser angioplasty of the right coronary artery. The procedure was complicated by perforation, which was successfully managed without complication with a Stack perfusion catheter. This report describes successful nonsurgical treatment of laser-induced coronary perforation and makes recommendations for avoiding this complication in other patients.     

Management of spontaneous perforation of esophageal cancer with covered self expanding metallic stents

Optimal management of esophageal perforation is controversial, especially in the presence of malignancy. Esophagectomy has traditionally been employed for patients with malignant perforations. However, in patients with advanced disease, other less invasive treatment options may be of benefit. We present two cases of spontaneous perforation of advanced esophageal cancer successfully managed by insertion of covered self-expanding metallic stents and a review of the literature.     

Coronary perforation as a potential complication derived from coronary thrombectomy with the X-Sizer device.

We report a case of coronary perforation after failed atherectomy with a 2 mm X-Sizer catheter in recent totally occluded right coronary artery. The perforation was successfully managed with a polytetrafluoroethylene-covered stent with satisfactory final angiographic results. Possible predictors of this complication with this new device are discussed.     

Deep intubation of 8 Fr guiding catheter to deliver coronary stent graft to seal coronary perforation: a case report.

Coronary perforation is an uncommon complication of angioplasty and is a challenging situation to manage. We describe a case of complex multivessel coronary angioplasty complicated by coronary perforation following balloon rupture that was successfully managed with a coronary stent graft. Delivery of the stent graft to the site of vessel rupture required deep intubation of an 8 Fr guiding catheter over the shaft of an inflated balloon. In addition to the availability of covered stents, it is essential to be familiar with various skills necessary to deploy these stents. Cathet Cardiovasc Intervent 2001;54:59-62.     

Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization.     

Emergency Placement of Platinum Coils to Prevent Cardiac Tamponade After Wire Perforation of an Occluded Venous Coronary Bypass Graft

A case is reported of a patient with impending cardiac tamponade due to vessel perforation following balloon angioplasty of an occluded venous bypass graft. Prolonged balloon inflation failed to seal the perforation. Leakage was controlled immediately by the delivery of two platinum coils into the perforation. In case of a vessel perforation during an attempt to recanalize an occluded coronary artery bypass, placement of intracoronary platinum coils to seal the perforation may prevent the development of cardiac tamponade.     

Transcatheter embolization of recanalized coronary artery fistula with Nit-Occlud device

Congenital coronary artery fistula is a rare anomaly with varying symptomatology that may be addressed with surgical or interventional closure. Recanalization after complete occlusion of a coronary artery fistula has only been reported after surgical but not after interventional closure. We present a case of coronary artery fistula recanalization after angiographically documented complete transcatheter occlusion with Gianturco coils. The fistula was successfully managed by transcatheter implantation of a Nit-Occlud system, originally designed for interventional closure of patent ductus arteriosus.     

Retrieval of Broken Export Catheter during Primary Angioplasty

Broken catheter fragments in a coronary artery during percutaneous coronary interventions although uncommon can potentially result in life-threatening consequences from the attended embolization, thrombus formation, and perforation. We report an unusual complication of a broken export catheter during primary angioplasty, which was successfully managed by inflated balloon-mediated retrieval technique.     

Conservative management of contained coronary perforation after percutaneous intervention.

Contained perforation of the coronary artery may occur following coronary intervention and is generally managed aggressively with acute percutaneous or surgical intervention. We report a case of contained perforation following intervention on an occluded right coronary artery, leading to lumenal compression by perivascular hematoma and reduced distal flow. This was managed conservatively with an excellent clinical and angiographic outcome.     

Successful Nonsurgical Management of Coronary Artery Perforation Aided by Implantation of a Bare Stent

Coronary artery perforation complicating percutaneous transluminal coronary angioplasty (PTCA) is rare but can be potentially fatal. We report a case of coronary artery dissection and perforation during PTCA that was successfully treated by implanting a bare stent with disappearance of angiographic contrast extravasation and performing one-time pericardiocentesis for unexpected, delayed cardiac tamponade thereby avoiding the need for surgery. The possibility of coronary angiography not detecting a small residual leak from the perforation is also discussed . (J Interven Cardiol 2000; 13:45–50)     

Novel economic treatment for coronary wire perforation: A case report

BACKGROUNDCoronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with embolization of coils, fat, thrombin, or collagen. We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation. we advocate this method as a simple method of managing distal vessel perforation.CASE SUMMARYA 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex. At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation. A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.CONCLUSIONThe use of a balloon remnant for embolization in coronary perforation presents a simple, efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome. Prevention remains the most important part with meticulous attention to the distal wire position, particularly with hydrophilic wires.     

Novel approach to coronary artery perforation repair

Coronary artery perforation (CAP) during percutaneous coronary intervention is a rare but serious complication. Treatment options of CAP include prolonged balloon inflation, covered stent, and coil embolization. Although most cases of CAP can be treated with prolonged balloon inflation, some cases, especially Ellis grade III CAP require covered stents or coiling. Covered stents may require a large bore guide catheter and have a high rate of restenosis, which can be a limiting factor in patients with severe peripheral arterial disease. Coil embolization is generally used in distal CAP because coiling in the proximal vessels results in a large territory of infarction. We present a case of an Ellis grade III CAP during rotational atherectomy successfully treated with a novel coiling technique whereby the thrombogenic coil extends through the perforation outside of the vessel, and the intraarterial portion of the coil is excluded from the lumen by drug‐eluting stent placement over the proximal portion of the coil.