Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
J Interv Cardiol. 2021 Nov 12;2021:9022326. doi: 10.1155/2021/9022326. eCollection 2021.
Coil embolization (CE) for coronary artery perforation (CAP) has not been thoroughly evaluated. This study aimed to evaluate the extent of myocardial damage and impact on cardiac function after CE for CAP.
A total of 110 consecutive patients treated with CE for CAP were retrospectively identified. The degree of myocardial damage and impact on cardiac function were evaluated.
Forty-nine (44.5%) cases involved chronic total occlusions. A guidewire was the cause of perforation in 97 (88.2%) patients. The success rate of CE was 98.2%. Almost all patients were prescribed either antiplatelet drugs or anticoagulant medication or both. Patients with perforation types III and IV were found to be prone to creatinine kinase (CK) elevation and epicardial main vessel perforation, thereby causing myocardial damage. No changes were noted in the ejection fraction (EF) in patients with type V distal perforation and collateral channel perforation, while patients with perforation of the epicardial main vessel may show impaired cardiac function afterward.
CE is safe and effective for treating CAP, especially when collateral channels and distal vessels are involved. Meanwhile, efforts should be taken to prevent CAP in epicardial main vessels since it may be difficult to treat with CS and cause myocardial damage when bailed out with CE leading to vessel sacrifice. We found that it was not necessary to change the anticoagulant regimen after CE owing to its ability to achieve robust hemostasis.
冠状动脉穿孔（CAP）的线圈栓塞（CE）尚未得到充分评估。本研究旨在评估 CAP 后 CE 所致心肌损伤程度及对心功能的影响。
回顾性分析了 110 例连续接受 CAP 治疗的 CE 患者。评估了心肌损伤程度和对心功能的影响。
49 例（44.5%）涉及慢性完全闭塞。97 例（88.2%）患者的穿孔原因是导丝。CE 的成功率为 98.2%。几乎所有患者均接受了抗血小板药物或抗凝药物或两者联合治疗。发现穿孔类型 III 和 IV 的患者容易出现肌酸激酶（CK）升高和心外膜主血管穿孔，从而导致心肌损伤。心外膜主血管穿孔的患者EF（射血分数）没有变化，而心外膜主血管穿孔的患者可能会出现心功能受损。
CE 治疗 CAP 安全有效，尤其是在涉及侧支和远端血管时。同时，应注意预防心外膜主血管 CAP，因为 CS 治疗困难，CE 挽救时可能导致心肌损伤，导致血管牺牲。我们发现，CE 后不必改变抗凝方案，因为它能够实现强大的止血效果。
