SPC365

Coronary artery perforations: 10-year experience of a large volume centre

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Nelson P. Cunha

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Nelson P. Cunha; Miguel Nobre Menezes; Tiago Rodrigues; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Beatriz Valente Silva; Joana Brito; Diogo Torres; Eduardo Infante de Oliveira; José Duarte; José Marques da Costa; Fausto j. Pinto; Pedro Pinto Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Coronary artery perforation (CAP) is a rare but a potential <span style="background-color:white"><span style="color:black">life-threatening complication of percutaneous coronary intervention (PCI). With increasingly complex procedures, the risk of such complications is increased. Thus, learning from these cases is of paramount importance.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim: to review the incidence, procedural details and outcomes of CAP in a high-volume PCI centre.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Single-centre retrospective study of consecutive patients (pts) with CAP between January 2010 and September 2020. Pts&rsquo; baseline characteristics were collected. Data regarding PCI (coronary anatomy, type of perforation and management strategy) were analysed. Clinical records were also analysed to review the immediate outcome, as well as major cardiovascular events (MACE) in the long term follow-up, defined as death, myocardial infarction (MI) or target lesion revascularization (TLR).</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: A total of 39 pts (mean age 74 &plusmn; 10 years, 56% male) had CAP during PCI (0,3% of all PCI). The relevant associated comorbidities were hypertension (87%), dyslipidemia (58%), diabetes (42%) and chronic kidney disease (40%).&nbsp; Wire related CAPs accounted for 31% (n=12) of the cases and ballooning/stenting related CAPs accounted for the remaining 69% (n=27). CAP occurred mostly in the left anterior descending artery (51%) followed by the circumflex (26%) and the right coronary artery (24%). 9 cases (23%) occurred in the setting of chronic total occlusion (CTO) PCI. Wire related CAPs were mostly associated non-workhorse wires: <em>Ultimate Bros 3</em> (25%); <em>Whisper</em> (25%); <em>Choice PT</em> (8%); <em>Fielder XT-A</em> (8%); <em>Ultimate Cross 3</em> (8%); <em>Gaia</em> (8%); <em><span style="font-family:&quot;Times New Roman&quot;,serif">Runthrough</span></em><em> NS</em> (8%). CAPs were tackled with prolonged proximal balloon inflation in 33% of the patients; prolonged proximal balloon inflation plus placement of a covered stent in 31%; placement of a covered stent alone in 46%; reversal of anticoagulation (RA) alone in 15%. In one case CAP was resolved with 2 microcoils. In the remaining patient fat embolization was successfully deployed to seal the perforation site. Tamponade requiring pericardiocentesis occurred in 6 pts (15%) and two pts needed emergent surgery (5%). &nbsp;The intra-procedural mortality was 5% (n=2).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a mean follow-up of 37 months, MACE occurred in 14 pts (36%). There were 2 cases of MI (1 in a perforated vessel that was treated with RA alone) and 2 cases of TLR (5%) due to restenosis of the covered stent. The overall mortality was 27%. </span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: CAPs were an important complication of PCI. The vast majority of cases were successfully treated and intra-procedural mortality was low, emphasizing the importance of swift action. Most cases required the use of specific devices, which should be routinely available &ldquo;on the shelf&rdquo; in all cath labs. Despite good short-term results, long-term outcomes were adversely affected, with significant rates of MACE, highlighting the need for awareness, especially in complex interventions. </span></span></p>