TY - JOUR
T1 - Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Alaswad, Khaldoon
AU - Krestyaninov, Oleg
AU - Khelimskii, Dmitrii
AU - Karmpaliotis, Dimitri
AU - Jaffer, Farouc A.
AU - Khatri, Jaikirshan J.
AU - Poommipanit, Paul
AU - Jaber, Wissam A.
AU - Rinfret, Stephane
AU - Nicholson, William
AU - Patel, Mitul P.
AU - Mahmud, Ehtisham
AU - Koutouzis, Michael
AU - Tsiafoutis, Ioannis
AU - Benton, Stewart M.
AU - Davies, Rhian E.
AU - Toma, Catalin
AU - Kerrigan, Jimmy L.
AU - Haddad, Elias V.
AU - Abi-Rafeh, Nidal
AU - ElGuindy, Ahmed M.
AU - Goktekin, Omer
AU - Mastrodemos, Olga C.
AU - Rangan, Bavana V.
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the Minneapolis Heart Institute Foundation, Minneapolis, Minnesota. 9, 10 REDCap is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; (4) procedures for importing data from external sources. The authors are grateful for the philanthropic support of our generous anonymous donors and the philanthropic support of Drs. Mary Ann and Donald A Sens, Mrs. Diane and Dr. Cline Hickok, Mrs. Wilma and Mr. Dale Johnson, Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund, the Roehl Family Foundation, and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease helped support this research project.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -“cavity spilling” coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.
AB - Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -“cavity spilling” coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.
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U2 - 10.1016/j.amjcard.2022.07.004
DO - 10.1016/j.amjcard.2022.07.004
M3 - Article
C2 - 36028387
AN - SCOPUS:85136556296
SN - 0002-9149
VL - 182
SP - 17
EP - 24
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -