JACC. Case reports · 2026
Management of Coronary Artery Perforations: A Stepwise, Case-Based Review From a High-Volume Center.
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Elsherif Ahmed, Khattak Sophia, Fawzy Ameenathul, Hussain Anwar, Ebrahimi Pouya, Shahid Farhan, Khan Sohail Q
Аннотация
BACKGROUND: Coronary artery perforation (CAP) is an uncommon but potentially life-threatening complication of percutaneous coronary intervention, occurring in 0.2% to 0.5% of routine cases and up to 3% of complex procedures such as chronic total occlusion interventions.
CASE SUMMARY: We report 9 consecutive cases of CAP managed at a high-volume tertiary center in the United Kingdom and involving varied coronary territories, mechanisms, and Ellis grades (I-V). All cases were initially managed with balloon tamponade. Definitive treatments included covered stents (n = 4), coil embolization (n = 2), and autologous clot embolization (n = 1), with no surgical bailout. Ellis class III perforations accounted for 4 cases, all requiring active intervention. Pericardial effusion occurred in 5 patients, with 3 patients requiring urgent pericardiocentesis. No in-hospital mortality was observed.
DISCUSSION: CAP management should be guided by the severity of perforation, the anatomical site, and the patient's hemodynamics. A structured algorithm involving early balloon tamponade, lesion-specific device selection, and structured escalation can prevent mortality and surgical bailout.
CASE SUMMARY: We report 9 consecutive cases of CAP managed at a high-volume tertiary center in the United Kingdom and involving varied coronary territories, mechanisms, and Ellis grades (I-V). All cases were initially managed with balloon tamponade. Definitive treatments included covered stents (n = 4), coil embolization (n = 2), and autologous clot embolization (n = 1), with no surgical bailout. Ellis class III perforations accounted for 4 cases, all requiring active intervention. Pericardial effusion occurred in 5 patients, with 3 patients requiring urgent pericardiocentesis. No in-hospital mortality was observed.
DISCUSSION: CAP management should be guided by the severity of perforation, the anatomical site, and the patient's hemodynamics. A structured algorithm involving early balloon tamponade, lesion-specific device selection, and structured escalation can prevent mortality and surgical bailout.