Ajluni S C, Glazier S, Blankenship L, O'Neill W W, Safian R D
Division of Cardiology (Department of Medicine), William Beaumont Hospital, Royal Oak, Michigan 48073-6769.
Cathet Cardiovasc Diagn. 1994 Jul;32(3):206-12. doi: 10.1002/ccd.1810320303.
Coronary perforation is a rare, but potentially catastrophic, complication of percutaneous coronary intervention. A retrospective review of the Cardiology Quality Assurance Database was performed for all percutaneous coronary interventions (n = 8,932) at William Beaumont Hospital from October 1988 to December 1992. Coronary artery perforation was reported in 35 patients (0.4%), including after percutaneous transluminal coronary angioplasty (PTCA, 11/7,905, 0.14%), transluminal extraction coronary atherectomy (TEC, 6/420, 1.3%), directional coronary atherectomy (DCA, 1/249, 0.25%), and excimer laser coronary angioplasty (ELCA, 5/242, 2%); and none after high-speed mechanical rotational atherectomy with the Rotablator (MRA, 0/116, 0%). Perforations were classified by coronary angiography as free perforations (n = 10), contained perforations (n = 17), or other types of perforation (n = 8). Although perforation was apparent in 32 (91%) of 35 angiograms, delayed cardiac tamponade occurred in 3 patients (9%), despite the absence of angiographic evidence for perforation at the time of the procedure. Causes of perforation were the guidewire in 7 (20%), an interventional device in 26 (74%), and indeterminate in 2 (6%). Complex B2 or C lesions accounted for 83% of perforations. Final treatment included conservative therapy (reversal of anticoagulation and/or PTCA) in 22 (63%) and surgical intervention (with or without bypass surgery) in 13 (37%). Serious clinical complications included cardiac tamponade in 6 (17%), blood transfusion in 12 (34%), myocardial infarction in 9 (26%), and death in 3 (9%).
冠状动脉穿孔是经皮冠状动脉介入治疗中一种罕见但可能具有灾难性的并发症。对1988年10月至1992年12月在威廉·博蒙特医院进行的所有经皮冠状动脉介入治疗（n = 8932例）的心脏病学质量保证数据库进行了回顾性分析。35例患者（0.4%）报告发生冠状动脉穿孔，包括经皮腔内冠状动脉成形术（PTCA，11/7905，0.14%）、腔内旋切冠状动脉斑块切除术（TEC，6/420，1.3%）、定向冠状动脉斑块切除术（DCA，1/249，0.25%）和准分子激光冠状动脉成形术（ELCA，5/242，2%）后；使用旋磨仪进行高速机械旋切术（MRA，0/116，0%）后无穿孔发生。根据冠状动脉造影将穿孔分为游离穿孔（n = 10）、局限性穿孔（n = 17）或其他类型穿孔（n = 8）。虽然35例血管造影中有32例（91%）可见穿孔，但3例患者（9%）发生了延迟性心脏压塞，尽管手术时血管造影无穿孔证据。穿孔原因是导丝导致7例（20%），介入器械导致26例（74%），2例（6%）原因不明。复杂B2或C型病变占穿孔的83%。最终治疗包括22例（63%）采用保守治疗（抗凝逆转和/或PTCA）和13例（37%）采用手术干预（有或无搭桥手术）。严重临床并发症包括6例（17%）心脏压塞、12例（34%）输血、9例（26%）心肌梗死和3例（9%）死亡。
