Gawalkar Atit A, Singh Navreet, Gupta Ankush, Barwad Parag
Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India.
Department of Cardiology, Air Force Central Medical Establishment, Subroto Park, New Delhi, 110010, India.
Eur Heart J Case Rep. 2021 Nov 1;5(11):ytab400. doi: 10.1093/ehjcr/ytab400. eCollection 2021 Nov.
Coronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it.
We hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP.
Distal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.
冠状动脉穿孔（CAP）虽罕见，但常是经皮冠状动脉介入治疗的危及生命的并发症。传统上认为环形导丝尖端或导丝弯曲更安全，因为其进入较小分支和假腔的风险降低。偶尔，导丝弯曲可能表明尖端进入夹层平面，或者环形导丝的推进可能导致小血管损伤进而穿孔。冠状动脉远端穿孔可能危及生命，弹簧圈、泡沫和凝血酶注射是广泛用于封堵的一些材料。
我们在此报告三例不同病例，说明环形导丝在远端血管系统中可因各种机制导致血管损伤，如高弹性回缩张力、非主导导丝尖端造成的夹层或硬导丝撕裂脆弱的小分支。所有这些机制均导致冠状动脉远端穿孔并引发心脏压塞。每个病例还展示了自体脂肪球栓塞治疗远端CAP的新技术。
冠状动脉远端穿孔常因导丝相关的血管损伤所致，且在亲水导丝中更常见。环形导丝尖端有时可提示血管损伤，其在冠状动脉内进一步推进可能导致严重的血管损伤和穿孔。冠状动脉远端穿孔的治疗具有挑战性，在此我们展示了通过选择性地将现成的自体脂肪球注入小冠状动脉来控制渗漏的步骤。
