ASSA14-08-02The efficacy and safety evaluation of intracoronary injection of thrombin treatment of coronary perforation induced by percutaneous coronary intervention

ObjectiveTo investigate the intracoronary injection of thrombin-induced coronary intervention in coronary perforation of the efficacy and safety evaluation.MethodsPatients January 2007 March 2014 parallel hospitalised coronary intervention of more than 6,000 cases, of which 16 cases of coronary perforation occurred surgery, 12 males and 4 females, aged 54 plus or minus 12 years, duration 2-10 years, mean 6.3 plus or minus 3.5 years. If bleeding occurs coronary perforation cardiac tamponade, pericardial puncture that immediately or catheter drainage, while expanding balloon blocked by pre-break, the small blood vessels distal perforation, centerless tamponade symptoms, from micro-catheter or over the well (OTW) balloon thrombin injection after injection of thrombin from finished OTW balloon microcatheter or a small amount of contrast agent bolus gently, then give protamine and in vivo heparin when necessary.Results16 cases of distal coronary vessel perforation, distal left anterior descending artery three cases, six cases of distal diagonal branch, circumflex obtuse marginal branch four cases, the right ventricular coronary collateral distal three cases, 10 cases because of the guide wire piercing extravascular, four cases when the balloon dilation of blood vessels rupture, 2 cases of stent implantation for vascular rupture. Three cases of pericardial puncture through the catheter drainage of pericardial effusion bloody 100-300 ml, then intracoronary injection of thrombin from 100 mg-300 mg bleeding stops within a balloon catheter through the micro or over the well (OTW). 13 cases of simple injection of thrombin 100-300 mg terminated after bleeding from the microcatheter or OTW balloon, blood pressure, heart rate stable. No obvious symptoms observed after 10-20 min and back to the ward. Followed up for 3 months to 1 year, the patient does not appear pericardial tamponade, heart failure, malignant arrhythmias, sudden death and other complications.ConclusionGive OTW balloon catheter or from micro-thrombin therapy or distal coronary collateral vessel perforation, blood exact effect, drug-related complications did not occur, but must avoid the flow of thrombin other vascular complications leading to blood clots.