Ramana Ravi K, Arab Dinesh, Joyal Dominique, Steen Lowell, Cho Leslie, Lewis Bruce, Liu Jayson, Loeb Henry, Leya Ferdinand
Division of Cardiology, Loyola University Medical Center, Hines V.A. Hospital, Maywood, Illinois, USA.
J Invasive Cardiol. 2005 Nov;17(11):603-5.
Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa).
We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined.
A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died.
Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods.
冠状动脉穿孔（CP）是经皮冠状动脉介入治疗（PCI）的一种严重并发症。鉴于介入技术、器械及糖蛋白抑制剂（GP IIb/IIIa）使用方面的进展，我们试图明确CP的发生率及预后情况。
我们回顾性分析了本机构4年间接受PCI治疗患者的记录。CP的发生率源自患者记录，随后通过回顾血管造影进行确认。穿孔按照先前定义分为1型、2型或3型。
共有4886例患者接受了PCI治疗。329例患者使用了旋切装置，2200例患者使用了GP IIb/IIIa。共识别出25例CP（发生率0.5%）。6例为1型（24%），10例为2型（40%），9例为3型（36%）。25例CP中有13例（52%）为C型病变，12例（48%）发生于钙化血管。所有1型穿孔均由冠状动脉导丝引起，6例CP中有4例发生于使用亲水超硬导丝时。2型穿孔在10例CP中有8例由冠状动脉导丝引起，2例由支架置入引起。2例2型CP患者发生了非ST段抬高型心肌梗死。3型穿孔在9例CP中有4例由支架置入引起，2例由旋切装置引起，3例由冠状动脉导丝引起。4例发生3型CP的患者接受了心包引流，5例发生心肌梗死，2例死亡。
1型和2型穿孔主要由亲水及硬导丝引起，无需心包引流或外科干预。3型穿孔更常与支架及器械使用相关。多数3型穿孔最初可通过经皮方法处理。
