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Perkütan Koroner Girişime Bağlı İyatrojenik Koroner Arter Perfosyonu Gelişen Hastaların Demografik Özelliklerinin ve Tedavilerinin Değerlendirilmesi: Tek Merkez Deneyimi

Year 2020, , 490 - 497, 15.09.2020
https://doi.org/10.31832/smj.732875

Abstract

Amaç: Bu çalışmanın amacı perkutan koroner girişim sırasında koroner arter perforasyonu gelişen hastaların demografik özelliklerini, insidansını, klinik özelliklerini, tedavi stratejilerilerini ve sonuçlarını değerlendirmektir.
Materyal ve Metod: 2015 ocak ve 2020 ocak ayları arasında perkütan koroner girişim yapılması sırasında koroner arter perforasyonu gelişen hastalar çalışmaya dahil edildi. Perkütan koroner girişim yapılan 10794 hastanın 25 tanesinde koroner arter perforasyonu gelişti. Kardiyak tamponad, acil perkütan veya baypas ile revaskülarizasyon gereksinimi, hastane içi ve 30 günlük mortalite sonlanım noktaları olarak belirlendi.
Bulgular:
Çalışmaya dahil edilen hastaların ortalama yaşı 62,5 ± 9.60 olup 17’si (%68) erkek idi. Sekiz hastada diyabet, 17 hastada hipertansiyon, 5 hastada kronik böbrek hastalığı öyküsü mevcuttu. Perkütan koroner girişim sırasında koroner arter perforasyonu gelişme insidansı %0.23 idi. Ellis sınıflamasına göre 8 (%32) hastada Ellis tip I, 9 (%36) hastada Ellis tip II, 7 (%28) hastada Ellis tip III ve 1 (%4) hastada Ellis tip III-CS koroner arter perforasyonu gözlendi. On iki hastada tamponad gözlenmiş olup bu hastalardan 7 tanesine hemen, 4 tanesine ise takiplerinde (>24 saat) perikardiyosentez yapıldı. Üç hastada tip I perforasyon başlangıçta fark edilmemiş olup takipleri sırasında tamponad gözlendi. Altı hasta hastanede ex oldu. Geriye kalan hastalarda 30 günde ölüm gözlenmedi. Bizim çalışmamızda advers olaylara Ellis sınıflaması tip I, II ve III/III-CS göre bakıldığında sırasıyla kardiyak tamponad %12, %20 ve %16, acil cerrahi gereksinimi sırasıyla %0, %4 ve % 0 iken ölüm sırasıyla %12, %4 ve %8 bulunmuştur.
Sonuç: Koroner arter perforasyonları çok nadir görülmesine rağmen mortalitesi çok yüksektir. Girişimsel kardiyologlar, özellikle perkütan koroner girişim sırasında gözden kaçabildiği için Ellis tip 1 perforasyonlara dikkat etmelidir. Bu verilerin daha çok hasta alınan çalışmalar ile değerlendirilmesi gerekir.

References

  • 1. Fasseas P, Orford JL, Panetta CJ, Bell MR, Denktas AE, Lennon RJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16298 procedures. Am Heart J 2004; 147:140-5.
  • 2. Bittl JA, Ryan TJ Jr, Keaney JF Jr, Tcheng JE, Ellis SG, Isner JM, et al. Coronary artery perforation during excimer laser coronary angioplasty. The Percutaneous Excimer Laser Coronary Angioplasty Registry. J Am Coll Cardiol 1993; 21:1158–1165.
  • 3. Holmes DR Jr, Reeder GS, Ghazzal ZM, Bresnahan JF, King SB 3rd, Leon MB, et al. Coronary perforation after excimer laser coronary angioplasty: The Excimer Laser Coronary Angioplasty Registry experience. J Am Coll Cardiol 1994; 23:330–335.
  • 4. Litvack F, Eigler N, Margolis J, Rothbaum D, Bresnahan JF, Holmes D, et al. Percutaneous excimer laser coronary angioplasty: results in the first consecutive 3000 patients. The ELCA Investigators. J Am Coll Cardiol 1994; 23:323–329.
  • 5. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation 1994; 90:2725–2730.
  • 6. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB 3rd, Loop FD, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988; 78:486–502.
  • 7. Shimony A, Zahger D, Van Straten M, Shalev A, Gilutz H, Ilia R, et al. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2009; 104:1674-7.
  • 8. Gunning M, Thomas M. Coronary artery perforation In: Redwood S, Curzen N, Thomas M. Oxford textbook of interventional cardiology. 2nd ed. Oxford textbooks in cardiology. New York, USA: Oxford University Press; 2010.p.734.
  • 9. Doll JA, Nikolsky E, Stone GW, Mehran R, Lincoff AM, Caixeta A, et al. Outcomes of patients with coronary artery perforation complicating percutaneous coronary intervention and correlations with the type of adjunctive antithrombotic therapy: pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials. J Interv Cardiol 2009; 22:453-9.
  • 10. Shimony A, Joseph L, Mottillo S, Eisenberg MJ. Coronary artery perforation during percutaneous coronary intervention: a systematic review and meta-analysis. Can J Cardiol 2011; 27:843.
  • 11. Witzke CF, Martin-Herrero F, Clarke SC, Pomerantzev E, Palacios IF. The changing pattern of coronary perforation during percutaneous coronary intervention in the New Device Era. J Invasive Cardiol 2004; 16:257-301.
  • 12. Meguro K, Ohira H, Nishikido T, Fujita M, Chinen T, Kikuchi T, et al. Outcome of prolonged balloon inflation for the management of coronary perforation. J Cardiol 2013; 61:206-9.
  • 13. Ben-Gal Y, Weisz G, Collins MB, Genereux P, Dangas GD, Teirstein PS, et al. Dual catheter technique for the treatment of severe coronary artery perforations. Catheter Cardiovasc Interv 2010; 75:708-12.
  • 14. Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiya Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol 2006; 98:370-4.
  • 15. Shirakabe A, Takano H, Nakamura S, Kikuchi A, Sasaki A, Yamamoto E, et al. Coronary perforation during percutaneous coronary intervention. Int Heart J 2007; 48:1-9.
  • 16. 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.
  • 17. Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mueller R, et al. Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Cathet Cardiovasc Intervent 2002; 56:353-60.
  • 18. Hernandez-Enriquez M, Lairez O, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, et al. Outcomes after use of covered stents to treat coronary artery perforations. Comparison of old and new-generation covered stents. J Interv Cardiol 2018; 31:617-623.
  • 19. Werner GS, Ahmed WH. Fenestration of a Papyrus PK covered stent to recover the occluded left main bifurcation after sealing a left main perforation during a CTO procedure. Cardiovasc Revasc Med 2017; 18:41–4.
  • 20. Sarlı B, Baktır AO, Sağlam H, Kurtul S, Doğan Y, Arınç H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J 2013; 35:164-6.
  • 21. Pershad A, Yarkoni A, Biglari D. Management of distal coronary perforations. J Invasive Cardiol 2008; 20:E187–91.
  • 22. George S, Cotton J, Wrigley B. Guidewire-induced coronary perforation successfully treated with subcutaneous fat embolisation: A simple technique available to all. Catheter Cardiovasc Interv 2015; 86:1186–8.
  • 23. Yoo BS, Yoon J, Lee SH, Kim JY, Lee HH, Ko JY, et al. Guidewire induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol form. Catheter Cardiovasc. Intervent 2001; 52:231–4.
  • 24. Dixon SR, Webster MW, Ormiston JA, Wattie WJ, Hammett CJ. Gelfoam embolization of a distal coronary artery guidewire perforation. Catheter Cardiovasc Interv 2000; 49:214-217.
  • 25. Tumscitz C, Lanzillotti V, Pirani L, Di Cesare AM, Scoccia A, Gallo F. Type III coronary perforation during chronic total occlusion percutaneous coronary interventions treated with Cyanoacrylate glue embolization: case report and review of the technique. Vessel Plus 2019; 3:20.
  • 26. Fischell TA, Moualla SK, Mannem SR. Intracoronary thrombin injection using a microcatheter to treat guidewire-induced coronary artery perforation. Cardiovasc Revasc Med 2011; 12:329–333.
  • 27. Meincke F, Kuck KH, Bergmann MW. Cardiac tamponade due to coronary perforation during percutaneous interventions successfully treated with microspheres. Clin Res Cardiol 2014; 103:325–327.
  • 28. Goel PK. Delayed and repeated cardiac tamponade following microleak in RCA successfully treated with intra arterial sterile glue injection. Catheter Cardiovasc Interv 2009; 73:797-800.
  • 29. Tanaka S, Nishigaki K, Ojio S, Yasuda S, Okubo M, Yamaki T, et al. Transcatheter embolization by autologous blood clot is useful management for small side branch perforation due to percutaneous coronary intervention guide wire. J Cardiol 2008; 52:285–289.
  • 30. Tseng CD, Chen CY, Chiang FT, Hsu KL, Lo HM, Tseng YZ, et al. Coronary artery perforation and delayed cardiac tamponande following balloon coronary angioplasty. J. Formos Med Assoc 1996; 95:789-792.
  • 31. Gruberg L, Pinnow E, Flood R, Bonnet Y, Tebeica M, Waksman R, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2000; 86:680-2.
  • 32. Liu F, Erbel R, Haude M, Ge J. Coronary arterial perforation: prediction, diagnosis, management, and prevention. In: Ellis SG, Holmes DR Jr, editors. Strategic approaches in coronary intervention. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2000.p.501-14.
Year 2020, , 490 - 497, 15.09.2020
https://doi.org/10.31832/smj.732875

Abstract

References

  • 1. Fasseas P, Orford JL, Panetta CJ, Bell MR, Denktas AE, Lennon RJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16298 procedures. Am Heart J 2004; 147:140-5.
  • 2. Bittl JA, Ryan TJ Jr, Keaney JF Jr, Tcheng JE, Ellis SG, Isner JM, et al. Coronary artery perforation during excimer laser coronary angioplasty. The Percutaneous Excimer Laser Coronary Angioplasty Registry. J Am Coll Cardiol 1993; 21:1158–1165.
  • 3. Holmes DR Jr, Reeder GS, Ghazzal ZM, Bresnahan JF, King SB 3rd, Leon MB, et al. Coronary perforation after excimer laser coronary angioplasty: The Excimer Laser Coronary Angioplasty Registry experience. J Am Coll Cardiol 1994; 23:330–335.
  • 4. Litvack F, Eigler N, Margolis J, Rothbaum D, Bresnahan JF, Holmes D, et al. Percutaneous excimer laser coronary angioplasty: results in the first consecutive 3000 patients. The ELCA Investigators. J Am Coll Cardiol 1994; 23:323–329.
  • 5. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation 1994; 90:2725–2730.
  • 6. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB 3rd, Loop FD, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988; 78:486–502.
  • 7. Shimony A, Zahger D, Van Straten M, Shalev A, Gilutz H, Ilia R, et al. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2009; 104:1674-7.
  • 8. Gunning M, Thomas M. Coronary artery perforation In: Redwood S, Curzen N, Thomas M. Oxford textbook of interventional cardiology. 2nd ed. Oxford textbooks in cardiology. New York, USA: Oxford University Press; 2010.p.734.
  • 9. Doll JA, Nikolsky E, Stone GW, Mehran R, Lincoff AM, Caixeta A, et al. Outcomes of patients with coronary artery perforation complicating percutaneous coronary intervention and correlations with the type of adjunctive antithrombotic therapy: pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials. J Interv Cardiol 2009; 22:453-9.
  • 10. Shimony A, Joseph L, Mottillo S, Eisenberg MJ. Coronary artery perforation during percutaneous coronary intervention: a systematic review and meta-analysis. Can J Cardiol 2011; 27:843.
  • 11. Witzke CF, Martin-Herrero F, Clarke SC, Pomerantzev E, Palacios IF. The changing pattern of coronary perforation during percutaneous coronary intervention in the New Device Era. J Invasive Cardiol 2004; 16:257-301.
  • 12. Meguro K, Ohira H, Nishikido T, Fujita M, Chinen T, Kikuchi T, et al. Outcome of prolonged balloon inflation for the management of coronary perforation. J Cardiol 2013; 61:206-9.
  • 13. Ben-Gal Y, Weisz G, Collins MB, Genereux P, Dangas GD, Teirstein PS, et al. Dual catheter technique for the treatment of severe coronary artery perforations. Catheter Cardiovasc Interv 2010; 75:708-12.
  • 14. Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiya Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol 2006; 98:370-4.
  • 15. Shirakabe A, Takano H, Nakamura S, Kikuchi A, Sasaki A, Yamamoto E, et al. Coronary perforation during percutaneous coronary intervention. Int Heart J 2007; 48:1-9.
  • 16. 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.
  • 17. Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mueller R, et al. Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Cathet Cardiovasc Intervent 2002; 56:353-60.
  • 18. Hernandez-Enriquez M, Lairez O, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, et al. Outcomes after use of covered stents to treat coronary artery perforations. Comparison of old and new-generation covered stents. J Interv Cardiol 2018; 31:617-623.
  • 19. Werner GS, Ahmed WH. Fenestration of a Papyrus PK covered stent to recover the occluded left main bifurcation after sealing a left main perforation during a CTO procedure. Cardiovasc Revasc Med 2017; 18:41–4.
  • 20. Sarlı B, Baktır AO, Sağlam H, Kurtul S, Doğan Y, Arınç H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J 2013; 35:164-6.
  • 21. Pershad A, Yarkoni A, Biglari D. Management of distal coronary perforations. J Invasive Cardiol 2008; 20:E187–91.
  • 22. George S, Cotton J, Wrigley B. Guidewire-induced coronary perforation successfully treated with subcutaneous fat embolisation: A simple technique available to all. Catheter Cardiovasc Interv 2015; 86:1186–8.
  • 23. Yoo BS, Yoon J, Lee SH, Kim JY, Lee HH, Ko JY, et al. Guidewire induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol form. Catheter Cardiovasc. Intervent 2001; 52:231–4.
  • 24. Dixon SR, Webster MW, Ormiston JA, Wattie WJ, Hammett CJ. Gelfoam embolization of a distal coronary artery guidewire perforation. Catheter Cardiovasc Interv 2000; 49:214-217.
  • 25. Tumscitz C, Lanzillotti V, Pirani L, Di Cesare AM, Scoccia A, Gallo F. Type III coronary perforation during chronic total occlusion percutaneous coronary interventions treated with Cyanoacrylate glue embolization: case report and review of the technique. Vessel Plus 2019; 3:20.
  • 26. Fischell TA, Moualla SK, Mannem SR. Intracoronary thrombin injection using a microcatheter to treat guidewire-induced coronary artery perforation. Cardiovasc Revasc Med 2011; 12:329–333.
  • 27. Meincke F, Kuck KH, Bergmann MW. Cardiac tamponade due to coronary perforation during percutaneous interventions successfully treated with microspheres. Clin Res Cardiol 2014; 103:325–327.
  • 28. Goel PK. Delayed and repeated cardiac tamponade following microleak in RCA successfully treated with intra arterial sterile glue injection. Catheter Cardiovasc Interv 2009; 73:797-800.
  • 29. Tanaka S, Nishigaki K, Ojio S, Yasuda S, Okubo M, Yamaki T, et al. Transcatheter embolization by autologous blood clot is useful management for small side branch perforation due to percutaneous coronary intervention guide wire. J Cardiol 2008; 52:285–289.
  • 30. Tseng CD, Chen CY, Chiang FT, Hsu KL, Lo HM, Tseng YZ, et al. Coronary artery perforation and delayed cardiac tamponande following balloon coronary angioplasty. J. Formos Med Assoc 1996; 95:789-792.
  • 31. Gruberg L, Pinnow E, Flood R, Bonnet Y, Tebeica M, Waksman R, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol 2000; 86:680-2.
  • 32. Liu F, Erbel R, Haude M, Ge J. Coronary arterial perforation: prediction, diagnosis, management, and prevention. In: Ellis SG, Holmes DR Jr, editors. Strategic approaches in coronary intervention. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2000.p.501-14.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Yusuf Can 0000-0002-4535-7367

Salih Şahinkuş 0000-0003-1558-5761

Publication Date September 15, 2020
Submission Date May 6, 2020
Published in Issue Year 2020

Cite

AMA Can Y, Şahinkuş S. Perkütan Koroner Girişime Bağlı İyatrojenik Koroner Arter Perfosyonu Gelişen Hastaların Demografik Özelliklerinin ve Tedavilerinin Değerlendirilmesi: Tek Merkez Deneyimi. Sakarya Tıp Dergisi. September 2020;10(3):490-497. doi:10.31832/smj.732875

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