Danek Barbara Anna, Karatasakis Aris, Tajti Peter, Sandoval Yader, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc, Yeh Robert W, Kandzari David E, Lembo Nicholas J, Patel Mitul P, Mahmud Ehtisham, Choi James W, Doing Anthony H, Lombardi William L, Wyman R Michael, Toma Catalin, Garcia Santiago, Moses Jeffrey W, Kirtane Ajay J, Hatem Raja, Ali Ziad A, Parikh Manish, Karacsonyi Judit, Rangan Bavana V, Khalili Houman, Burke M Nicholas, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Healthcare System/UT Southwestern Medical Center, Dallas, Texas.
Minneapolis Heart Institute, Minneapolis, Minnesota.
Am J Cardiol. 2017 Oct 15;120(8):1285-1292. doi: 10.1016/j.amjcard.2017.07.010. Epub 2017 Jul 24.
Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.
冠状动脉穿孔是慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的一种潜在并发症。我们分析了2012年至2017年在2049例患者中进行的2097例CTO PCI。患者年龄为65±10岁，85%为男性，36%曾接受冠状动脉旁路移植术。技术成功率和手术成功率分别为88%和87%。围手术期主要不良心血管事件发生率为2.6%。85例患者（4.1%）发生冠状动脉穿孔；Ellis 1级、2级和3级穿孔的发生率分别为21%、26%和52%。穿孔在老年患者和曾接受冠状动脉旁路移植术的患者中更常见（61%对35%，p<0.001）。发生穿孔的病例在血管造影上更为复杂（日本多中心CTO注册评分3.0±1.2对2.5±1.3，p<0.001）。12例（14%）发生穿孔的患者出现需要心包穿刺的心脏压塞。患者年龄、既往PCI、右冠状动脉CTO靶病变、钝性或无残端、使用顺行夹层再入路和逆行入路与穿孔有关。穿孔患者围手术期主要不良心血管事件的调整优势比为15.04（95%置信区间7.35至30.18）。总之，在经验丰富的术者进行的当代CTO PCI中，穿孔相对少见，且与患者基线特征和血管造影复杂性相关，这需要使用先进的通过技术。在大多数情况下，穿孔不会导致需要心包穿刺的心脏压塞，但它们与技术成功率和手术成功率降低、围手术期主要不良事件增加以及手术效率降低有关。
