Shirakabe Akihiro, Takano Hitoshi, Nakamura Shunichi, Kikuchi Arifumi, Sasaki Asako, Yamamoto Eisei, Kawashima Shuji, Takagi Gen, Fujita Nobuhiko, Aoki Satoshi, Asai Kuniya, Yoshikawa Masatomo, Kato Koji, Yamamoto Takeshi, Takayama Morimasa, Takano Teruo
First Department of Internal Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
Int Heart J. 2007 Jan;48(1):1-9. doi: 10.1536/ihj.48.1.
Coronary perforation is an undesirable complication during percutaneous coronary intervention (PCI). We reviewed the cases of overt coronary perforation in our institute and analyzed their clinical backgrounds, the characteristics of the target lesion, management, and clinical outcomes. Between 1991 and 2005, we experienced 12 cases (0.35%) of coronary perforation in a total of 3415 PCI procedures. The perforation occurred during the use of debulking devices in 3 cases, immediately after stenting in 2, immediately after postdilatation of the stent in 2, and during wiring in 3 cases. Restoration was attempted by long inflation of a balloon in 7 cases, implantation of a covered stent graft in 1, and emergency surgical repair in 1 case. Subsequent cardiac tamponade occurred in 3 patients who required pericardiocentesis, and 1 patient died due to congestive heart failure. Administration of protamine was effective in stopping the bleeding in 6 patients, whereas continuation of antiplatelet therapy resulted in no overt rebleeding. Coronary perforation during PCI is a rare complication but is associated with significant morbidity and mortality. Intravenous administration of protamine is effective when it is used in conjunction with nonsurgical devices for initial management of perforation.
冠状动脉穿孔是经皮冠状动脉介入治疗（PCI）期间一种不良并发症。我们回顾了我院明显冠状动脉穿孔的病例，并分析了其临床背景、靶病变特征、处理方法及临床结局。1991年至2005年期间，在总共3415例PCI手术中，我们共经历了12例（0.35%）冠状动脉穿孔病例。穿孔发生在3例使用减容装置时、2例支架置入后即刻、2例支架后扩张后即刻以及3例导丝操作期间。7例尝试通过长时间球囊扩张进行修复，1例植入覆膜支架移植物，1例行急诊外科修复。3例患者随后发生心脏压塞，需要进行心包穿刺，1例患者因充血性心力衰竭死亡。6例患者使用鱼精蛋白有效止血，而继续抗血小板治疗未导致明显再出血。PCI期间的冠状动脉穿孔是一种罕见并发症，但与显著的发病率和死亡率相关。在使用非手术装置对穿孔进行初始处理时联合静脉注射鱼精蛋白是有效的。
