Double set up technique as a bailout of diagonal branch coronary perforation: a case report

  • Muhammad Syukri Department of Cardiology and Vascular Medicine, Dr. M. Djamil Hospital, Padang, Indonesia
  • Mefri Yanni Department of Cardiology and Vascular Medicine, Dr. M. Djamil Hospital, Padang, Indonesia
  • Masrul Syafri Department of Cardiology and Vascular Medicine, Dr. M. Djamil Hospital, Padang, Indonesia
  • Shindu Phalguna Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
  • Alles Firmansyah Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
  • Merlin Sari Mutma Indah Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
  • Ivan Mahendra Department of Cardiology and Vascular Medicine, M. Hatta Brain Hospital, Bukittinggi, Indonesia
  • Hadi Zulkarnain Department of Cardiology and Vascular Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
Keywords: complication, coronary artery, stent
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Abstract

Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). A 55-year-old male with a history of implanted stent on the left main ostium to the proximal left circumflex artery (LCX) and distal right coronary artery, and chronic total occlusion (CTO) on ostium left anterior descending (LAD). PCI was performed using a stiff wire to cross the CTO body in LAD. We performed an injection and confirmed the presence of extravasation. We successfully managed to stop the bleeding by placing the tips of floppy wire that were cut into pieces. A drainage pathway was made through thoracotomy for pericardial effusion. Angiography showed persisting extravasation at the wire insertion site. We then made our own covered stent. We implanted on the osteal LAD until proximal LCX. Repeated angiography showed no contrast extravasated from the perforation site, and the patient was stabilized and discharged.

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References

  1. Doll JA, Nikolsky E, Stone GW, Mehran R, Lincoff AM, Caixeta A, et al. Outcomes of patients with coronary artery perforation complicating percutaneous coronary intervention and correlations with the type of adjunctive antithrombotic therapy: pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials. J Interv Cardiol. 2009;22(5):453−9. https://doi.org/10.1111/j.1540-8183.2009.00494.x

  2. Shimony A, Joseph L, Mottillo S, Eisenberg MJ. Coronary artery perforation during percutaneous coronary intervention: a systematic review and meta-analysis. Can J Cardiol. 2011;27(6):843−50. https://doi.org/10.1016/j.cjca.2011.04.014

  3. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994;90(6):2725-30. https://doi.org/10.1161/01.CIR.90.6.2725

  4. Ajluni SC, Glazier S, Blankenship L, O'Neill WW, Safian RD. Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. Cathet Cardiovasc Diagn. 1994;32(3):206−12. https://doi.org/10.1002/ccd.1810320303

  5. Januszek R, Bryniarski L, Siudak Z, Malinowski KP, Bryniarski KL, Surdacki A, et al. Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary artery perforations within chronic total occlusions. Postepy Kardiol Interwencyjnej. 2020;16(4):399-409. https://doi.org/10.5114/aic.2020.101764

  6. Doll JA, Hira RS, Kearney KE, Kandzari DE, Riley RF, Marso SP, et al. Management of percutaneous coronary intervention complications: algorithms from the 2018 and 2019 Seattle Percutaneous Coronary Intervention Complications Conference. Circ Cardiovasc Interv. 2020;13(6):e008962. https://doi.org/10.1161/CIRCINTERVENTIONS.120.008962

  7. Hartono B, Widito S, Munawar M. Sealing of a dual feeding coronary artery perforation with homemade spring guidewire. Cardiovasc Interv Ther. 2015;30(4):347−50. https://doi.org/10.1007/s12928-014-0299-8

  8. Dippel EJ, Kereiakes DJ, Tramuta DA, Broderick TM, Shimshak TM, Roth EM, et al. Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: an algorithm for percutaneous management. Catheterization Cardiovasc Interv. 2001;52(3):279-86. https://doi.org/10.1002/ccd.1065

  9. Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, et al. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv. 2013;6(2):128−36. https://doi.org/10.1016/j.jcin.2012.10.011

  10. Dixon SR, Webster MW, Ormiston JA, Wattie WJ, Hammett CJ. Gelfoam embolization of a distal coronary artery guidewire perforation. Catheter Cardiovasc Interv. 2000;49(2):214−7. https://doi.org/10.1002/(SICI)1522-726X(200002)49:2<214::AID-CCD23>3.0.CO;2-1

  11. Qin Q, Chang S, Xu R, Fu M, Chen L, Ge L, et al. Short and long-term outcomes of coronary perforation managed by coil embolization: a single-center experience. Int J Cardiol. 2020;298:18−21. https://doi.org/10.1016/j.ijcard.2019.07.091

  12. Lemmert ME, van Bommel RJ, Diletti R, Wilschut JM, de Jaegere PP, Zijlstra F, et al. Clinical characteristics and management of coronary artery perforations: a single-center 11-year experience and practical overview. J Am Heart Assoc. 2017;6(9):e007049. https://doi.org/10.1161/JAHA.117.007049

  13. Hachinohe D, Kashima Y, Okada Y, Kanno D, Kobayashi K, Kaneko U, et al. Coil embolization for coronary artery perforation: a retrospective analysis of 110 patients. J Interv Cardiol. 2021;2021:9022326. https://doi.org/10.1155/2021/9022326

  14. Irie T. New embolization microcoil consisting of firm and flexible segments: preliminary clinical experience. Cardiovasc Intervent Radiol. 2006;29(6):986−90. https://doi.org/10.1007/s00270-005-0364-x

  15. Kilic ID, Fabris E, Serdoz R, Caiazzo G, Foin N, Abou-Sherif S, et al. Coronary covered stents. EuroIntervention. 2016;12(10):1288−95. https://doi.org/10.4244/EIJV12I10A210

  16. Harnek J, James SK, Lagerqvist B. Very long-term outcome of coronary covered stents: a report from the SCAAR registry. EuroIntervention. 2019;14(16):1660−7. https://doi.org/10.4244/EIJ-D-18-00855

  17. Schächinger V, Hamm CW, Münzel T, Haude M, Baldus S, Grube E, et al. A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts. J Am Coll Cardiol. 2003;42(8):1360−9. https://doi.org/10.1016/S0735-1097(03)01038-6

  18. Pienvichit P, Waters J. Successful closure of coronary artery perforation using makeshift stent sandwich. Catheter Cardiovasc Interv. 2001;54(2):209−13. https://doi.org/10.1002/ccd.1269

  19. Song X, Qin Q, Chang S, Xu R, Fu M, Lu H, et al. Clinical outcomes of self-made polyurethane-covered stent implantation for the treatment of coronary artery perforations. J Interv Cardiol. 2021;2021:6661763. https://doi.org/10.1155/2021/6661763

Published
2024-05-08
How to Cite
1.
Syukri M, Yanni M, Syafri M, Phalguna S, Firmansyah A, Indah MSM, Mahendra I, Zulkarnain H. Double set up technique as a bailout of diagonal branch coronary perforation: a case report. Med J Indones [Internet]. 2024May8 [cited 2024Jul.20];33(1):55-0. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/7266
Section
Case Report/Series