Coronary perforation during conventional time domain optical coherence tomography
Autor: | Chong-Jin Kim, Hui-Jeong Hwang, Eun-Sun Jin, Byung-Hyun Joe, Chang-Bum Park |
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Rok vydání: | 2012 |
Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Iatrogenic Disease Perforation (oil well) Percutaneous coronary intervention Stent Middle Aged medicine.disease Coronary Vessels Stenosis Postoperative Complications Intravascular ultrasound Conventional PCI Coronary stent medicine Humans Female Radiology Angioplasty Balloon Coronary Cardiology and Cardiovascular Medicine business Tomography Optical Coherence Coronary Artery Perforation |
Zdroj: | International Journal of Cardiology. 155:e14-e15 |
ISSN: | 0167-5273 |
Popis: | Coronary artery perforation is a rare, but well recognized, compli-cation of percutaneous coronary intervention (PCI), with a reportedincidence of 0.14–0.35%, but with a mortality as high as 10% [1].Optical coherence tomography (OCT) has emerged as a powerfultool for use in stent assessment, and, within a short time, it hasbecome the modality of choice for study of stent and vascularinteractions in vivo. However, in a first generation pullback Time-Domain OCT imaging wire system (TD-OCT; M2 OCT systems andImageWire, LightLab Imaging, Inc, Westford, MA), blood clearancewas achievedby proximal balloonocclusion andflushingof the vesselusing the distal end holes of the occlusion balloon (Helios OcclusionBalloon Catheter, Goodman-Avantec Vascular Corp, Sunnyvale, CA).We report on a case of coronary perforation during first generationTD-OCT imaging as routine follow-up angiography.A 64-year-old woman with a history of previous percutaneouscoronary intervention (PCI) was admitted for follow-up coronaryangiography and OCT imaging. She had undergone PCI at the leftanterior descending artery (LAD) 1 year ago and had no anginalsymptoms after PCI. Cardiac examination was unremarkable, with aheart rate of 72 bpm and blood pressure (BP) 130/80 mm Hg.Diagnostic coronary angiogram, which was performed via the righttransradial approach using 6 Fr equipment, revealed no in-stentrestenosis of previously implanted stents with moderate distal leftanterior descending(LAD)artery stenosis (Fig. 1). TD-OCT imaging wasperformedusingaroutineprocedure,suchasproximalballoonocclusionatproximalLADand flushingwithRinger'slactateat1 ml/s.DuringOCT,abrupt BP depression and loss of consciousness developed. Followingimmediate removal of the OCT device and occluding balloon, coronaryangiography showed a huge coronary perforation with extravasation atthe distal LAD-D2 bifurcated lesion. We reinserted a guidewire and aconventionalballoonwasinflated just proximal to thelesion in order tosealtheperforation.Resuscitationwithinotropesandpericardiocentesiswere performed.The contrast leakcontinued inspiteofalongperiodofballoon inflation; therefore, a 3.0×15 mm Coronary Stent Graft™ wasinserted,butfailedtosealtheperforationduetoasmallcoronaryarteryand bulky graft stent (Fig. 2). The patient was transferred to theoperating room for surgical repair. Following sternotomy, a hugeperforated artery measuring approximately 6 –7mm was observed.Leftinternalmammaryartery(LIMA)graftstoLADandasaphenousveingrafttodiagonalwereplaced.Followingsuturingofthepericardiumandsternum, the patient returned to the CCU. She expired due to suddencardiac arrest at 7 days after surgery.OCT is high resolution, and, combined with the blood-free environ-ment, provides a substantial advantage for the study of coronary stent,when compared with previous intravascular ultrasound (IVUS) [2].Thistool enables detailed evaluation of tissue coverage and stent malapposi-tion in follow-up analysis. This specific parameter has been used as a |
Databáze: | OpenAIRE |
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