PERFORATIONS AFTER PERCUTANEOUS CORONARY INTERVENTIONS - CLINICAL, ANGIOGRAPHIC, AND THERAPEUTIC OBSERVATIONS

Coronary perforation is a rare, but potentially catastrophic, complica tion of percutaneous coronary intervention. A retrospective review of the Cardiology Quality Assurance Database was performed for all percut aneous coronary interventions (n = 8,932) at William Beaumont Hospital from October 1988 to December 1992. Coronary artery perforation was r eported in 35 patients (0.4%), including after percutaneous translumin al coronary angioplasty (PTCA, 11/7,905, 0.14%), transluminal extracti on coronary atherectomy (TEC, 6/420, 1.3%), directional coronary ather ectomy (DCA, 1/249, 0.25%), and excimer laser coronary angioplasty (EL CA, 5/242,2%); and none after high-speed mechanical rotational atherec tomy with the Rotablator (MRA, 0/116, 0%). Perforations were classifie d by coronary angiography as free perforations (n = 1 0), contained pe rforations (n = 17), or other types of perforation (n = 8). Although p erforation was apparent in 32 (91%) of 35 angiograms, delayed cardiac tamponade occurred in 3 patients (9%), despite the absence of angiogra phic evidence for perforation at the time of the procedure. Causes of perforation were the guidewire in 7 (20%), an interventional device in 26 (74%), and indeterminate in 2 (6%). Complex B, or C lesions accoun ted for 83% of perforations. Final treatment included conservative the rapy (reversal of anticoagulation and/or PTCA) in 22 (63%) and surgica l intervention (with or without bypass surgery) in 13 (37%). Serious c linical complications included cardiac tamponade in 6 (17%), blood tra nsfusion in 12 (34%), myocardial infarction in 9 (26%), and death in 3 (9%). (C) 1994 Wiley-Liss, Inc.