Mirza Aram J, Taha Abdulsalam Y, Aldoori Jaafar S, Hawas Jawad M, Hassan Kawa W
1 Department of Cardiology, Slemani Cardiac Hospital, Sulaimaniyah, Region of Kurdistan, Iraq.
2 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimaniyah, Sulaimaniyah, Region of Kurdistan, Iraq.
Asian Cardiovasc Thorac Ann. 2018 Feb;26(2):101-106. doi: 10.1177/0218492318755182. Epub 2018 Jan 16.
Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.
背景 冠状动脉穿孔是经皮冠状动脉介入治疗中一种罕见但严重的并发症。我们旨在评估伊拉克苏莱曼尼亚冠状动脉穿孔的处理情况。方法 对我们2009年至2016年的医疗记录进行回顾性分析，确定了24例冠状动脉穿孔患者（男性15例，女性9例）。平均年龄为60±9.2岁（范围40 - 74岁）。进行了标准诊断性血管造影或经皮介入治疗。冠状动脉穿孔通过症状恶化、低血压或I型（管腔外火山口）、II型（心肌或心包显影）或III型（造影剂外渗或腔隙溢出）穿孔的血管造影证据来诊断。狭窄程度分为>85%、60% - 85%或<60%。一旦诊断出冠状动脉穿孔，停用肝素，停用抗血小板药物，并抽吸心包积液。II型和III型冠状动脉穿孔使用覆膜支架或反复短暂球囊扩张进行封堵。结果 最常受损的动脉是左前降支（n = 14，58.3%）。II型和III型冠状动脉穿孔占大多数（n = 18，75%）。13例（54.2%）患者有严重冠状动脉狭窄。穿孔由支架（n = 10）、血管成形术导丝（n = 8）和球囊（n = 6）引起。15处穿孔用覆膜支架封堵，2处通过球囊扩张封堵，7处自行愈合。13例（54.2%）患者的心包积液被引流。无一例患者需要手术，也无死亡病例。结论 本研究的特点是冠状动脉穿孔发生率低且主要通过覆膜支架进行早期处理。
