Tassanawiwat Worawut, Biondi-Zoccai Giuseppe G L, Sangiorgi Giuseppe, Iakovou Ioannis, Tsagalou Eleutheria, Melzi Gloria, Ge Lei, Morici Nuccia, Corvaja Nicola, Colombo Antonio
Int J Cardiol. 2006 Jan 26;106(3):418-9. doi: 10.1016/j.ijcard.2005.01.017.
Vessel perforation is an uncommon but potentially life-threatening complication of percutaneous coronary intervention and is often associated with the use of atheroablative devices. While effective management means are currently available, such as PTFE-covered stent, pericardiocentesis, and perfusion balloon, a timely and skillful approach is of paramount importance to solve this dreadful complication. We hereby describe a case of saphenous vein graft (SVG) perforation occurring after cutting balloon angioplasty for in-stent restenosis. Despite the immediate occurrence of cardiac arrest due to massive extravasation of contrast in the mediastinum with pericardial tamponade, deep catheter intubation enabled the deployment of two PTFE-covered stents and subsequent sealing of the leak with repeated inflation of a perfusion balloon, while hemopericardium was drained by pericardiocentesis. This clinical vignette emphasizes the role of optimal backup in order to deploy life-saving devices and successfully manage life-threatening pericardial tamponade due to SVG rupture.
血管穿孔是经皮冠状动脉介入治疗中一种罕见但可能危及生命的并发症，且常与使用斑块消融装置有关。虽然目前有有效的处理方法，如使用聚四氟乙烯（PTFE）覆膜支架、心包穿刺术和灌注球囊，但及时且熟练的处理方法对于解决这一可怕的并发症至关重要。我们在此描述一例在使用切割球囊血管成形术治疗支架内再狭窄后发生的大隐静脉桥血管（SVG）穿孔病例。尽管由于造影剂在纵隔大量外渗并伴有心包填塞导致心脏骤停立即发生，但通过深导管插管得以部署两个PTFE覆膜支架，并随后通过反复充盈灌注球囊封闭渗漏处，同时通过心包穿刺术引流心包积血。这个临床案例强调了最佳备用措施的作用，以便能够部署挽救生命的装置并成功处理因SVG破裂导致的危及生命的心包填塞。
