CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Coronary Artery Perforation
Viroj Muangsillapasart1, Tanyarat Aramsareewong2
Chulabhorn Hospital, Thailand1, Phramongkutklao Hospital, Thailand2,
A 69-year-old Thai male with no known underlying disease presented with typical chest discomfort on exertion for several months.The previous coronary angiogram revealed TVD and PCI to RCA was performed 4 weeks ago. On this admission, he was arranged for elective PCI to LAD. His blood pressure was 130/70 mmHg and physical examination showed unremarkable finding.
Coronary artery perforation is an infrequent complication of PCI but it is associated with high morbidity and mortality. There are several risk factors of coronary artery perforation such as using of oversized balloons or stents, complex coronary anatomy, excessive post dilatation, and use of atheroablative procedures. Hemodynamic status, individual coronary anatomy, and CAP location are associated with determining treatment strategies. Conventional treatment includes prolonged balloon inflation, covered stent, coiling, distal embolization or surgery. Additionally, urgent and serial echocardiographic monitoring is essencial and plays an important role for long-term follow-up.