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

Year 2020, Volume: 10 Issue: 3, 490 - 497, 15.09.2020

Yusuf Can Salih Şahinkuş

https://doi.org/10.31832/smj.732875

Cited By: 1

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.

Keywords

Koroner Arter Perfosyonu, perkütan koroner girişim, greft kaplı stent

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