Interventional Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York 10032, USA.
Catheter Cardiovasc Interv. 2010 Apr 1;75(5):708-12. doi: 10.1002/ccd.22331.
To evaluate the outcome of patients with coronary perforations who were treated with the dual catheter approach.
Coronary artery perforation is a grave complication of percutaneous coronary intervention (PCI) with high mortality and morbidity. Treating a coronary artery perforation with two catheters through dual access enables a rapid delivery of covered stent or coils to the vessel, without losing control of the perforation site.
We retrospectively reviewed all patients who had a severe coronary perforation during a PCI in our center, and compared outcomes of patients treated with the dual versus the traditional single guiding catheter approach.
Between April 2004 and October 2008, 13,466 PCI's were performed in Columbia University - New York Presbyterian Medical Center. There were 33 documented cases of coronary perforations during that period of time (0.245%), among these, 26 were angiographically severe (Ellis type 2 or 3 perforations). Eleven patients were treated acutely with a dual catheter technique whereas the other fifteen patients were treated using a single guiding catheter. In the dual catheter group one patient expired after emergent CABG (9.1%), and four patients underwent emergent paricardiocentesis (36.4%). In patients treated with single catheter, there were three deaths (20%), two surgical explorations (13.3%), eight emergent pericardiocenthesis (53.3%), and one event of severe anoxic brain damage (6.7%).
The dual catheter technique is a relatively safe and reproducible approach to treat a PCI induced severe coronary artery perforation, and may improve outcome compared to historical series.
评估采用双导管方法治疗冠状动脉穿孔患者的结果。
冠状动脉穿孔是经皮冠状动脉介入治疗（PCI）的严重并发症，死亡率和发病率都很高。通过双入路使用两个导管治疗冠状动脉穿孔，可以迅速将覆盖支架或线圈输送到血管，而不会失去对穿孔部位的控制。
我们回顾性地审查了在我们中心进行的 PCI 过程中发生严重冠状动脉穿孔的所有患者，并比较了采用双导管与传统单引导导管方法治疗的患者的结果。
2004 年 4 月至 2008 年 10 月期间，哥伦比亚大学-纽约长老会医疗中心共进行了 13466 例 PCI。在此期间有 33 例经影像学证实的冠状动脉穿孔病例（0.245%），其中 26 例为血管造影严重穿孔（Ellis 2 型或 3 型穿孔）。11 例患者采用双导管技术进行急性治疗，而另外 15 例患者则采用单引导导管治疗。在双导管组中，1 例患者在紧急 CABG 后死亡（9.1%），4 例患者进行了紧急心包穿刺（36.4%）。在接受单导管治疗的患者中，有 3 例死亡（20%），2 例手术探查（13.3%），8 例紧急心包穿刺（53.3%），1 例严重缺氧性脑损伤（6.7%）。
与历史系列相比，双导管技术是一种相对安全且可重复的方法，可用于治疗 PCI 引起的严重冠状动脉穿孔，并可能改善结果。
