Incidence, Treatment, and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention

Vennela Avula, Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Bavana V. Rangan, Alessandra A. Gutierrez, M. Nicholas Burke, Santiago Garcia, Michael Mooney, Paul Sorajja, Jay H. Traverse, Anil Poulose, Ivan Chavez, Yale Wang, Mario Goessl, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


OBJECTIVES: To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI). BACKGROUND: Coronary perforation is a potentially life-threatening PCI complication. METHODS: We examined the clinical, angiographic, and procedural characteristics, management, and outcomes of coronary perforation at a tertiary care institution. RESULTS: Between 2014 and 2019, perforation occurred in 70 of 10,278 PCIs (0.7%). Patient age was 71 ± 12 years, 66% were men, and 30% had prior coronary artery bypass graft surgery. Among perforation cases, the prevalence of chronic total occlusions was 33%, moderate/severe calcification was 66% and moderate/severe tortuosity was 41%. The frequency of Ellis class 1, 2, and 3 perforations was 14%, 50%, and 36%, respectively. Most (n = 51; 73%) were large vessel perforations, 16 (23%) were distal vessel perforations and 3 (4%) were collateral vessel perforations (1 septal and 2 epicardial). Hypotension occurred in 26%, pericardial effusion in 36% and tamponade in 13%; 47% of perforations did not have clinical consequences. Perforations were most often treated with prolonged balloon inflation (63%), reversal of anticoagulation (39%), and covered stent implantation (33%). Technical and procedural success were 73% and 60%, respectively, and major periprocedural adverse cardiac events occurred in 21% of the patients. Three patients (4%) required emergent CABG surgery and four (6%) died. CONCLUSIONS: Coronary perforation is an infrequent complication of PCI. Most perforations are large vessel perforations and often require further intervention. The incidence of death or emergent cardiac surgery is low.

Original languageEnglish (US)
Pages (from-to)E499-E504
JournalThe Journal of invasive cardiology
Issue number7
StatePublished - Jul 1 2022
Externally publishedYes


  • coronary perforation
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)


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