Gaxiola E, Browne K F
University of Florida, Gainesville, USA.
Cathet Cardiovasc Diagn. 1998 Apr;43(4):474-6. doi: 10.1002/(sici)1097-0304(199804)43:4<474::aid-ccd29>3.0.co;2-i.
An 82-year-old woman undergoing percutaneous transluminal coronary angioplasty experienced perforation of the terminal portion of the left anterior descending coronary artery caused by guidewire trauma. The coronary artery perforation was successfully closed using a vascular occlusion system consisting of individual thrombogenic coils delivered to the site. Coronary artery perforation (CAP) during percutaneous transluminal coronary angioplasty (PTCA) has been reported to occur in less than 1% of cases. The incidence seems to be higher with the new interventional devices, e.g., DCA, TEC, and laser CAP may result in pericardial hemorrhage and cardiac tamponade or a coronary artery fistula to either the left or right ventricle. The management of CAP may include prolonged balloon inflations, reversal of anticoagulation, pericardiocentesis, and emergency surgery. Proximal perforations sometimes can be managed with vein covered stents. We describe another option in the treatment of distal CAP using a vascular occlusion system.
一名82岁接受经皮腔内冠状动脉成形术的女性患者，因导丝损伤导致左前降支冠状动脉终末段穿孔。使用由逐个输送至穿孔部位的促血栓形成线圈组成的血管闭塞系统成功封闭了冠状动脉穿孔。据报道，经皮腔内冠状动脉成形术（PTCA）期间冠状动脉穿孔（CAP）的发生率低于1%。使用新的介入装置（如定向冠状动脉旋切术、腔内斑块旋切术和激光）时，发生率似乎更高。CAP可能导致心包出血和心脏压塞或冠状动脉瘘入左心室或右心室。CAP的处理措施可能包括延长球囊充气时间、逆转抗凝、心包穿刺和急诊手术。近端穿孔有时可用带静脉覆盖物的支架处理。我们描述了使用血管闭塞系统治疗远端CAP的另一种选择。
