Incidence, treatment, and outcomes of coronary perforation during chronic total occlusion percutaneous coronary interventions: Insights from a multicenter registry
Danek B, Karatasakis A, Hatem R, Karmpaliotis D, Alaswad K, Jaffer F, Yeh R, Kandzari D, Lembo N, Patel M, Mahmud E, Choi J, Doing A, Lombardi W, Wyman RM, Toma C, Uretsky B, Garcia S, Moses J, Kirtane A, Ali Z, Karacsonyi J, Sandoval Y, Rangan B, Khalili H, Banerjee S, Brilakis E. Incidence, treatment, and outcomes of coronary perforation during chronic total occlusion percutaneous coronary interventions: Insights from a multicenter registry. Catheter Cardiovasc Interv. 2017;89:S49-S50.
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.