Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention
Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiog...
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| Veröffentlicht in: | The American journal of cardiology 2022-11, Vol.182, p.17-24 |
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| creator | Kostantinis, Spyridon Simsek, Bahadir Karacsonyi, Judit Alaswad, Khaldoon Krestyaninov, Oleg Khelimskii, Dmitrii Karmpaliotis, Dimitri Jaffer, Farouc A. Khatri, Jaikirshan J. Poommipanit, Paul Jaber, Wissam A. Rinfret, Stephane Nicholson, William Patel, Mitul P. Mahmud, Ehtisham Koutouzis, Michael Tsiafoutis, Ioannis Benton, Stewart M. Davies, Rhian E. Toma, Catalin Kerrigan, Jimmy L. Haddad, Elias V. Abi-Rafeh, Nidal ElGuindy, Ahmed M. Goktekin, Omer Mastrodemos, Olga C. Rangan, Bavana V. Burke, M. Nicholas Brilakis, Emmanouil S. |
| description | Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p |
| doi_str_mv | 10.1016/j.amjcard.2022.07.004 |
| format | Article |
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Nicholas ; Brilakis, Emmanouil S.</creator><creatorcontrib>Kostantinis, Spyridon ; Simsek, Bahadir ; Karacsonyi, Judit ; Alaswad, Khaldoon ; Krestyaninov, Oleg ; Khelimskii, Dmitrii ; Karmpaliotis, Dimitri ; Jaffer, Farouc A. ; Khatri, Jaikirshan J. ; Poommipanit, Paul ; Jaber, Wissam A. ; Rinfret, Stephane ; Nicholson, William ; Patel, Mitul P. ; Mahmud, Ehtisham ; Koutouzis, Michael ; Tsiafoutis, Ioannis ; Benton, Stewart M. ; Davies, Rhian E. ; Toma, Catalin ; Kerrigan, Jimmy L. ; Haddad, Elias V. ; Abi-Rafeh, Nidal ; ElGuindy, Ahmed M. ; Goktekin, Omer ; Mastrodemos, Olga C. ; Rangan, Bavana V. ; Burke, M. Nicholas ; Brilakis, Emmanouil S.</creatorcontrib><description>Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -“cavity spilling” coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2022.07.004</identifier><language>eng</language><publisher>New York: Elsevier Inc</publisher><subject>Angioplasty ; Autografts ; Balloon treatment ; Calcification ; Cardiovascular disease ; Coronary artery ; Coronary vessels ; Dissection ; Embolization ; Heart attacks ; Heart surgery ; Hypertension ; Implants ; Intervention ; Mortality ; Occlusion ; Patients ; Perforation ; Stents ; Success ; Tamponade ; Trends</subject><ispartof>The American journal of cardiology, 2022-11, Vol.182, p.17-24</ispartof><rights>2022 Elsevier Inc.</rights><rights>2022. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-3312d238747e0e143a51ee7ffcba2097a996ccd97c28e697afb7ae0ee3144df33</citedby><cites>FETCH-LOGICAL-c370t-3312d238747e0e143a51ee7ffcba2097a996ccd97c28e697afb7ae0ee3144df33</cites><orcidid>0000-0001-9416-9701 ; 0000-0003-1099-681X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2722299280?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids></links><search><creatorcontrib>Kostantinis, Spyridon</creatorcontrib><creatorcontrib>Simsek, Bahadir</creatorcontrib><creatorcontrib>Karacsonyi, Judit</creatorcontrib><creatorcontrib>Alaswad, Khaldoon</creatorcontrib><creatorcontrib>Krestyaninov, Oleg</creatorcontrib><creatorcontrib>Khelimskii, Dmitrii</creatorcontrib><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Jaffer, Farouc A.</creatorcontrib><creatorcontrib>Khatri, Jaikirshan J.</creatorcontrib><creatorcontrib>Poommipanit, Paul</creatorcontrib><creatorcontrib>Jaber, Wissam A.</creatorcontrib><creatorcontrib>Rinfret, Stephane</creatorcontrib><creatorcontrib>Nicholson, William</creatorcontrib><creatorcontrib>Patel, Mitul P.</creatorcontrib><creatorcontrib>Mahmud, Ehtisham</creatorcontrib><creatorcontrib>Koutouzis, Michael</creatorcontrib><creatorcontrib>Tsiafoutis, Ioannis</creatorcontrib><creatorcontrib>Benton, Stewart M.</creatorcontrib><creatorcontrib>Davies, Rhian E.</creatorcontrib><creatorcontrib>Toma, Catalin</creatorcontrib><creatorcontrib>Kerrigan, Jimmy L.</creatorcontrib><creatorcontrib>Haddad, Elias V.</creatorcontrib><creatorcontrib>Abi-Rafeh, Nidal</creatorcontrib><creatorcontrib>ElGuindy, Ahmed M.</creatorcontrib><creatorcontrib>Goktekin, Omer</creatorcontrib><creatorcontrib>Mastrodemos, Olga C.</creatorcontrib><creatorcontrib>Rangan, Bavana V.</creatorcontrib><creatorcontrib>Burke, M. Nicholas</creatorcontrib><creatorcontrib>Brilakis, Emmanouil S.</creatorcontrib><title>Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention</title><title>The American journal of cardiology</title><description>Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -“cavity spilling” coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.</description><subject>Angioplasty</subject><subject>Autografts</subject><subject>Balloon treatment</subject><subject>Calcification</subject><subject>Cardiovascular disease</subject><subject>Coronary artery</subject><subject>Coronary vessels</subject><subject>Dissection</subject><subject>Embolization</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Hypertension</subject><subject>Implants</subject><subject>Intervention</subject><subject>Mortality</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Perforation</subject><subject>Stents</subject><subject>Success</subject><subject>Tamponade</subject><subject>Trends</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1r3DAQhkVoodskP6Eg6KWHtasP78o6lbDNx0LC9rA5C2U8TmRsKZXkQH9F_3K0bKDQS07DoGdezfAQ8oWzmjO-_j7UdhrAxq4WTIiaqZqx5oQseKt0xTWXH8iCMSYqzRv9iXxOaSgt56v1gvzdenAdesAlvUN4st6lKS3pPqLNE_q8pNZ3dDdnCBMmGnq6CTF4G__Qi5ixlF8Y-xBtdsHTn3N0_pFungrigO5DtiPdAYxzOjwXFOZsPYY5_cvZ-pLzUv4qyBn52Nsx4flbPSX3V5f7zU11u7vebi5uK5CK5UpKLjohW9UoZMgbaVccUfU9PFjBtLJarwE6rUC0uC59_6BsIVHypul6KU_Jt2Pucwy_Z0zZTC4BjuNxOSMUUyvd6rYt6Nf_0CHM0ZftCiWE0Fq0rFCrIwUxpBSxN8_RTeU8w5k5aDKDedNkDpoMU6ZoKnM_jnNYrn1xGE0Cd_DRuYiQTRfcOwmvz6egiA</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Kostantinis, Spyridon</creator><creator>Simsek, Bahadir</creator><creator>Karacsonyi, Judit</creator><creator>Alaswad, Khaldoon</creator><creator>Krestyaninov, Oleg</creator><creator>Khelimskii, Dmitrii</creator><creator>Karmpaliotis, Dimitri</creator><creator>Jaffer, Farouc A.</creator><creator>Khatri, Jaikirshan J.</creator><creator>Poommipanit, Paul</creator><creator>Jaber, Wissam A.</creator><creator>Rinfret, Stephane</creator><creator>Nicholson, William</creator><creator>Patel, Mitul P.</creator><creator>Mahmud, Ehtisham</creator><creator>Koutouzis, Michael</creator><creator>Tsiafoutis, Ioannis</creator><creator>Benton, Stewart M.</creator><creator>Davies, Rhian E.</creator><creator>Toma, Catalin</creator><creator>Kerrigan, Jimmy L.</creator><creator>Haddad, Elias V.</creator><creator>Abi-Rafeh, Nidal</creator><creator>ElGuindy, Ahmed M.</creator><creator>Goktekin, Omer</creator><creator>Mastrodemos, Olga C.</creator><creator>Rangan, Bavana V.</creator><creator>Burke, M. 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Nicholas</au><au>Brilakis, Emmanouil S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention</atitle><jtitle>The American journal of cardiology</jtitle><date>2022-11-01</date><risdate>2022</risdate><volume>182</volume><spage>17</spage><epage>24</epage><pages>17-24</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n = 503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -“cavity spilling” coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.</abstract><cop>New York</cop><pub>Elsevier Inc</pub><doi>10.1016/j.amjcard.2022.07.004</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9416-9701</orcidid><orcidid>https://orcid.org/0000-0003-1099-681X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2022-11, Vol.182, p.17-24 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2707598988 |
| source | Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Angioplasty Autografts Balloon treatment Calcification Cardiovascular disease Coronary artery Coronary vessels Dissection Embolization Heart attacks Heart surgery Hypertension Implants Intervention Mortality Occlusion Patients Perforation Stents Success Tamponade Trends |
| title | Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T10%3A38%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Incidence,%20Mechanisms,%20Treatment,%20and%20Outcomes%20of%20Coronary%20Artery%20Perforation%20During%20Chronic%20Total%20Occlusion%20Percutaneous%20Coronary%20Intervention&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Kostantinis,%20Spyridon&rft.date=2022-11-01&rft.volume=182&rft.spage=17&rft.epage=24&rft.pages=17-24&rft.issn=0002-9149&rft.eissn=1879-1913&rft_id=info:doi/10.1016/j.amjcard.2022.07.004&rft_dat=%3Cproquest_cross%3E2722299280%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2722299280&rft_id=info:pmid/&rft_els_id=S0002914922007391&rfr_iscdi=true |