Holck Emil Nielsen, Andreasen Lene Nyhus, Hansen Emilie Kjær, Thomsen Jesper Skovhus, Brüel Annemarie, Johansen Peter, Christiansen Evald Høj, Jakobsen Lars
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Hospitalsenheden Midt, Viborg, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
JACC Case Rep. 2025 Apr 2;30(7):103382. doi: 10.1016/j.jaccas.2025.103382.
Perforation of a major epicardial coronary artery during percutaneous coronary interventions (PCIs) is potentially lethal.
Here the authors present a novel treatment strategy for managing a perforation in the bifurcation core with a complex 2-stent technique using polyurethane-covered stents. Specialized equipment for chronic total occlusion (CTO) interventions was used for recanalization of the main vessel and side branch. The procedure was tested in a bench setting and validated using 3-dimensional optical coherence tomography and micro-computed tomography.
The case emphasizes the need for complex CTO-PCI techniques in the treatment of acute non-CTO PCI.
To the best of our knowledge, this is the first report of a complex bifurcation technique for treatment of an epicardial perforation.
TAKE-HOME MESSAGE: It is feasible to treat an epicardial perforation in the bifurcation core with an advanced 2-stent technique. Ex vivo training for rare and severe complications may improve procedural outcome.
经皮冠状动脉介入治疗（PCI）期间主要心外膜冠状动脉穿孔可能致命。
本文作者介绍了一种新颖的治疗策略，采用聚氨酯涂层支架的复杂双支架技术处理分叉核心部位的穿孔。使用慢性完全闭塞（CTO）介入的专用设备对主血管和侧支进行再通。该操作在实验台上进行了测试，并通过三维光学相干断层扫描和微型计算机断层扫描进行了验证。
该病例强调了在急性非CTO PCI治疗中采用复杂CTO-PCI技术的必要性。
据我们所知，这是首例关于治疗心外膜穿孔的复杂分叉技术的报告。
采用先进的双支架技术治疗分叉核心部位的心外膜穿孔是可行的。针对罕见和严重并发症的体外训练可能会改善手术结果。
