Coronary Artery Dissection and Perforation Complicating Percutaneous Coronary Intervention

Jason H. Rogers, MD; John M. Lasala, MD, PhD

Disclosures

J Invasive Cardiol. 2004;16(9) 

In This Article

Abstract and Introduction

Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Despite its numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. We herein review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, large registries of PCI-related coronary artery perforations are summarized. The management of coronary artery dissection and perforation is discussed at length, including the application of newer modalities such as covered stents.

Percutaneous coronary intervention (PCI) is increasingly utilized in the treatment of coronary artery disease. Despite its numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary dissection and perforation. Up to 30% of all conventional balloon angioplasties result in angiographically significant coronary artery dissection.[1,2] In recent registries, perforation has been reported to occur in 0.3–0.6% of all patients undergoing PCI.[3–6] The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue, such as transluminal extraction coronary atherectomy, directional coronary atherectomy, excimer laser coronary angioplasty and high-speed mechanical rotational atherectomy. We herein review the incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era.

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