Greft Stent Implantation for Coronary Artery Perforation After Percutaneous Coronary Intervention

Abstract

Coronary artery perforation is a rare, but life-threatening complication of percutaneous coronary interventions (PCI). The occurrence of perforation increased with newer interventional devices and techniques like rotablation, excimer laser coronary angioplasty, and routine high pressure balloon dilatation or chronic total occlusion interventions. We describe a case of unexpected Ellis stage 3 perforation following "routine" direct stenting of left anterior descending coronary artery (LAD) stenosis. The perforation was successfully sealed by a polytetrafluoroethylene-covered stent graft. In addition to the availability of covered stents, it is essential to be familiar with various skills necessary for successful management of these complications.

Keywords

• Coronary artery disease; angioplasty, transluminal, percutaneous coronary; stents.

Primer Perkütan Koroner Girişim Sonrası Gelişen Yatrojenik Koroner Perforasyona Başarılı Kaplı Stent Emplantasyonu

Abstract

Koroner arter perforasyonu, perkütan koroner işlem esnasında çok nadir görülen fakat hayatı tehdit eden bir komplikasyondur. Bu komplikasyonun insidansı yeni girişimsel tekniklerin kullanıma girmesiyle artmıştır; örneğin, rotablatör, excimer lazer koroner anjiyoplasti, rutin yüksek basınçlı balon dilatasyonu ya da kronik total oklüzyonlara girişim. Biz rutin LAD (sol ön inen koroner arter) stentleme işlemini takiben gelişen Ellis evre 3 koroner perforasyon olgusunu paylaşmak istedik. Perforasyonu politetrafloroetilen kaplı stentle başarılı bir şekilde kapatıldı. Karşımıza çıkabilecek bu tür komplikasyonların başarılı bir şekilde yönetimi için greft kaplı stentlerin laboratuvarda hazır bulundurulması gerekmektedir

Keywords

• Koroner arter hastalığı; anjiyoplasti, translüminal, perkütan koroner; stent.

References

1. Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiya Y, et al. Treatment of coronary artery perforations complicating percu- taneous coronary intervention with a polytetrafluoroethylene-co- vered stent graft. Am J Cardiol 2006;98:370-4.
2. Shirakabe A, Takano H, Nakamura S, Kikuchi A, Sasaki A, Yama- moto E, et al. Coronary perforation during percutaneous coronary intervention. Int Heart J 2007;48:1-9.
3. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al. Increased coronary perforation in the new device era. Inci- dence, classification, management, and outcome. Circulation 1994;90:2725-30.
4. Briguori C, Nishida T, Anzuini A, Di Mario C, Grube E, Colombo A. Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures. Circulation 2000;102:3028-31.
5. Ajluni S, Glazier S, Blankenship L, O’Neill WW, Safian RD. Per- foration after ercutaneous coronary interventions: clinical, angi- ographic and therapeutic observations. Cathet Cardiovasc Diagn 1994;32:206-12.
6. Javaid A, Buch AN, Satler LF, Kent KM, Suddath WO, Lindsay J Jr, et al. Management and outcomes of coronary artery perfo- ration during percutaneous coronary intervention. Am J Cardiol 2006;98:911-4.
7. Subraya RG, Tannenbaum AK. Successful sealing of perforation of saphenous vein graft by coronary stent. Cathet Cardiovasc In- tervent 2000;50:460-2.
8. Ramsdale DR, Mushahwar SS, Morris JL. Repair of coronary artery perforation after rotastenting by implantation of the jostent covered stent. Cathet Cardiovasc Diagn 1998;45:310-3.

9. Pienvichit P, Waters J. Successful closure of coronary artery per- foration using makeshift stent sandwich. Cathet Cardiovasc Inter- vent 2001;54:209-13.
10. Salwan R, Mathur A, Seth A. Deep intubation of 8 Fr guiding cat- heter to deliver coronary stent graft to seal coronary perforation: a case report. Cathet Cardiovasc Intervent 2001;54:59-62.
11. Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mu- eller R, et al. Results of the jostent coronary stent graft implanta- tion in various clinical settings: procedural and follow-up results. Cathet Cardiovasc Intervent 2002;56:353-60.
12. Takano M, Yamamoto M, Inami S, Xie Y, Murakami D, Okamatsu K, et al. Delayed endothelialization after polytetrafluoroethylene-cove- red stent implantation for coronary aneurysm. Circ J 2009;73:190-3.