Coronary Artery Perforation, Subepicardial Hematoma, and Cardiac Tamponade After Complex Percutaneous Coronary Intervention
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SUBMITTER: Corona S
PROVIDER: S-EPMC8543142 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Coronary artery intramural hematoma is a rare complication of percutaneous coronary intervention which develops from intimal tear of coronary artery and propagates by blood accumulation along the medial surface of adjacent segment. Fifty-three-year-old male presented with nonexertional chest pain; he was referred after a positive stress test with+ moderate lateral wall ischemia. Coronary angiography showed 80% lesion in mid-left anterior descending artery (mLAD). Angiogram after angioplasty with 2.0 mm × 15 mm balloon and 3.0 mm × 15 mm drug-eluting-stent demonstrated a new stenotic lesion distal to stented mLAD segment. Subsequently, an overlapping 3.0 mm × 30 mm stent was placed with effective restoration of blood flow through LAD. During percutaneous coronary intervention (PCI), balloon predilatation can result in plaque fracture and stent deployment may cause intimal tear forming intramural hematoma which can lead to post-PCI myocardial infarction necessitating prompt detection by intravascular imaging with intravascular ultrasound and optical coherence tomography. Management is based on individual patient's characteristics and includes medical therapy, angiographic surveillance or repeat PCI.
| S-EPMC9364049 | biostudies-literature
Project description:BackgroundPericardiocentesis is frequently performed when fluid needs to be removed from the pericardial sac, for both therapeutic and diagnostic purposes, however, it can still be a high-risk procedure in inexperienced hands and/or an emergent setting.Case presentationA 78-year-old male made an emergency call complaining of the back pain. When the ambulance crew arrived at his home, he was in a state of shock due to cardiac tamponade diagnosed by portable echocardiography. The pericardiocentesis was performed using a puncture needle on site, and the patient was immediately transferred to our hospital by helicopter. Contrast-enhanced computed tomography showed a small protrusion of contrast media on the inferior wall of the left ventricle, suggesting cardiac rupture due to acute myocardial infarction. Emergency coronary angiography was then performed, which confirmed occlusion of the posterior descending branch of the left circumflex coronary artery. In addition, extravasation of contrast medium due to coronary artery perforation was observed in the acute marginal branch of the right coronary artery. We considered that coronary artery perforation had occurred as a complication of the pericardial puncture. We therefore performed transcatheter coil embolization of the perforated branch, and angiography confirmed immediate vessel sealing and hemostasis. After the procedure, the patient made steady progress without a further increase in pericardial effusion, and was discharged on the 50th day after admission.ConclusionsWhen performing pericardial drainage, it is important that the physician recognizes the correct procedure and complications of pericardiocentesis, and endeavors to minimize the occurrence of serious complications. As with the patient presented, coil embolization is an effective treatment for distal coronary artery perforation caused by pericardiocentesis.
| S-EPMC7845111 | biostudies-literature
Project description:Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.
| S-EPMC4591893 | biostudies-literature
Project description:We describe the case of an 86-year-old man with an extensive cardiac history, including previous coronary artery bypass grafting, who experienced a delayed extracardiac hematoma, 350 mL in volume, after retrograde chronic total occlusion-percutaneous coronary intervention. The patient was successfully treated with resultant liquefaction of the hematoma. (Level of Difficulty: Advanced.).
| S-EPMC9175200 | biostudies-literature
Project description:BackgroundPatients who undergo coronary artery bypass graft (CABG) surgery rarely develop global pericardial tamponade due to pericardial adhesions. There are no reports of multiple coronary artery perforations following global pericardial tamponade during percutaneous coronary intervention (PCI) in these patients.Case summaryA 52-year-old male who underwent CABG surgery developed effort angina pectoris. Coronary angiography demonstrated chronic total occlusion (CTO) of the first diagonal branch with severe stenosis of the second diagonal branch. Because his chest pain did not improve with medical therapy and ischaemia of the left ventricular anterolateral wall was confirmed by myocardial scintigraphy, PCI was performed. The second diagonal branch stenosis was passed anterogradely by a 0.014-inch coronary angioplasty guidewire, while the first diagonal branch CTO was recanalized by side-branch intravascular ultrasonography-guided parallel wiring. After stent deployment, coronary artery perforation at the distal end of the second diagonal branch was detected via contrast injection. We immediately performed intravascular haemostasis, leading to the disappearance of contrast. However, multiple bleeding sites were visualized by angiography at different sites of coronary arteries, including the circumflex artery. Although intravascular haemostasis is a standard procedure, we could not control rebleeding. Despite intensive care, the patient died.DiscussionIncreased tissue pressure due to bleeding possibly led to global pericardial tamponade with multiple coronary artery perforations. We report a rare case of a patient with multiple coronary artery perforations during coronary intervention.
| S-EPMC8669552 | biostudies-literature
Project description:BackgroundSeveral updated meta-analyses comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) for left main coronary artery disease (LM CAD) have been published recently. However, the risk of false-positive results could be high in conventional updated meta-analyses due to repetitive testing of accumulating data. Therefore, we compared these treatment approaches via trial sequential analysis (TSA).MethodsThe MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for published randomized controlled trials (RCTs) or subgroups of RCTs comparing PCI and CABG in patients with LM CAD. The primary outcome was major cardiac and cerebrovascular adverse events (MACCE). TSA was used to confirm the conclusions derived from conventional meta-analysis.ResultsSix RCTs with 4700 patients were included. PCI was associated with a greater risk of MACCE compared with CABG (pooled relative risk [RR] 1.21, 95% confidence interval [CI]: 1.05-1.40, P = .008). In addition, PCI resulted in a significantly higher risk of revascularization than CABG (pooled RR 1.61, 95% CI: 1.33-1.95, P < .0001). TSA provided firm evidence for the reduction of MACCE and revascularization with CABG compared with PCI (cumulative z-curve crossed the monitoring boundary). In the subgroup analysis, CABG was better than PCI in patients with SYNTAX score >32 (pooled RR 1.41, 95% CI: 1.12-1.76, P = .003), which was confirmed by the TSA. There was no difference in patients with a SYNTAX score from 0 to 32.ConclusionsIn patients with LM CAD, CABG may be better than PCI for reducing MACCE due to a reduced risk of revascularization. CABG remains the first choice for LM CAD patients with high anatomic complexity, while PCI could be an alternative for those with low-to-moderate anatomic complexity.
| S-EPMC5662302 | biostudies-literature
Project description:Right coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient's haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention.A 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection.The polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended.
| S-EPMC5663076 | biostudies-literature
Project description: Not available
| S-EPMC5509921 | biostudies-literature
Project description:Percutaneous coronary intervention (PCI) in patients with chronic kidney disease is associated with a high-risk of contrast-induced nephropathy. We describe a case of ultra-low contrast PCI guided using optical coherence tomography using normal saline for clearance complicated by distal wire perforation treated with embolization. (Level of Difficulty: Intermediate.).
| S-EPMC8304529 | biostudies-literature
Project description:AimsThe aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD).Methods and resultsIn this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups. A sensitivity analysis was performed using a 6-month SAQ-AF.At 1 year, 373 (26.1%) out of 1428 patients reported RA. Whilst RA at 1 year was an independent correlate of repeat revascularization at 5 years [18.3 vs. 11.5%; adjusted hazard ratio (HR): 1.54; 95% confidence interval (CI): 1.10-2.15], it was not associated with all-cause death at 10 years (22.1 vs. 21.6%; adjusted HR: 1.11; 95% CI: 0.83-1.47). These results were consistent when stratified by the modality of revascularization (PCI or CABG) or by anginal frequency. The sensitivity analysis replicating the analyses based on 6-month angina status resulted in similar findings.ConclusionAmong patients with LMCAD and/or 3VD, patient-reported RA at 1 year post-revascularization was independently associated with repeat revascularization at 5 years; however, it did not significantly increase 10-year mortality, irrespective of the primary modality of revascularization or severity of RA.
| S-EPMC10405129 | biostudies-literature