Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: An algorithm for percutaneous management

Coronary perforation is an uncommon but potentially life-threatening compli cation of percutaneous coronary intervention. The use of both atheroablativ e technologies for coronary intervention and adjunctive platelet glycoprote in blockade pharmacology may increase the incidence of or risk for life-thr eatening bleeding complications following the occurrence of coronary artery perforation. The interventional database for 6,214 percutaneous coronary i nterventions performed between January 1995 and June 1999 was analyzed. Hos pital charts and cine angiograms for all patients identified in the databas e as having had coronary perforation were reviewed. Coronary perforation co mplicated 0.58% of all procedures and was more commonly observed in patient s with a history of congestive heart failure and following use of atheroabl ative interventional technologies (2.8%). There was no association of abcix imab therapy with either the incidence of or classification for coronary pe rforation. Adverse clinical outcomes (death, emergency surgical exploration ) were related to the angiographic classification of perforation and were m ore frequently observed in patients who experienced a class 3 coronary perf oration. These data suggest that specific clinical and procedural demograph ic factors are associated with the occurrence and severity of angiographic coronary perforation. An angiographic perforation class-specific algorithm for treatment of coronary perforation is proposed. (C) 2001 Wiley-Liss, Inc .