Incidence, treatment, and outcomes of coronary perforation during chronic total occlusion percutaneous coronary interventions: Insights from a multicenter registry

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Conference Proceeding

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Catheter Cardiovasc Interv


Background: Coronary perforation is a potential procedural complication of chronic total occlusion (CTO) percutaneouscoronary intervention (PCI). Methods: We analyzed data from 1952 patients who underwent CTO PCI in amulticenter registry. Results: Mean patient age was 65±10 years, 85% were men, 36% had prior coronary artery bypass grafting (CABG). Overall technical and procedural success were 88% and 87%. A major adverse cardiovascular event (death, myocardial infarction, stroke, repeat revascularization, pericardiocentesis) occurred in 2.6%. Coronary perforation occurred in 80 patients (4.1%). Perforation was more frequent in older patients (71±9 vs. 65±10 years, p<0.001) and with prior CABG (61% vs. 35%, p<0.001). Perforation occurred at the CTO target vessel in 75%, an epicardial collateral in 16%, and a septal collateral in 9% of cases. Cases with perforation were angiographically more complex (moderate/severe calcification 81% vs. 56%, p<0.001; blunt/no stump 75% vs. 53%, p=0.002; poor distal landing zone 52% vs. 36%, p=0.023; J-CTO score 3.0±1.2 vs. 2.5±1.2, p=0.001, PROGRESS-CTO Complications score 4.4±1.8 vs. 3.2±1.9, p<0.001). Ten perforations resulted in tamponade requiring pericardiocentesis (12.5% of perforations, 0.5% of overall cohort). Figure 1 shows treatment and concurrent complications (related or unrelated to perforation) stratified by perforation Ellis type. Conclusion: Coronary perforationoccurs relatively infrequently in contemporary CTO PCI, and is associated with patient age, prior CABG, and angiographic complexity. A small proportion of perforations required pericardiocentesis.



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