PCI术中冠状动脉穿孔

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-24 DOI:10.1016/j.jaccas.2025.105068

Ravi Sankar Tulluru DM, Karthik Gopinath DM, Viji Samuel Thomson DM, John Jose E DM, Ommen K. George DM

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引用次数: 0

摘要

冠状动脉穿孔（CAP）是经皮冠状动脉介入治疗中一种罕见但严重的并发症，死亡率为10%至20%。它的相关性随着程序的复杂性和设备使用的扩大而增加。我们报告了一个10年的单中心病例系列，包括21例CAP病例，重点介绍了5例关键病例：III型CAP采用覆盖支架合并侧支闭塞；钙化穿孔合并支架血栓形成；远端金属丝穿孔致死；慢性全闭塞相关性CAP的盘绕和手术治疗；和延迟恶化的IV型CAP。总体而言，III型CAP最常见（52%），左前降支最常受累（57%）。治疗包括覆盖支架71%，卷绕术14%，手术2例。4例死亡，2例发生支架内血栓形成或支架内再狭窄。本系列强调CAP机制；治疗策略;以及及时识别、成像指导和机构准备的重要性。

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Coronary Artery Perforation During PCI

Background

Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention, with a mortality rate of 10% to 20%. Its relevance is increasing with procedural complexity and expanded device use.

Case Summary

We present a 10-year, single-center case series of 21 CAP cases, highlighting 5 key cases: type III CAP treated with a covered stent complicated by side branch occlusion; calcified perforation complicated by stent thrombosis; distal wire perforation with fatal outcome; chronic total occlusion-related CAP managed with coiling and surgery; and type IV CAP with delayed deterioration. Overall, type III CAP was most common (52%), and the left anterior descending artery was most frequently involved (57%). Management included covered stent in 71%, coiling in 14%, and surgery in 2 cases. Four patients died, and 2 patients developed stent thrombosis or in-stent restenosis.

Discussion

This series emphasizes CAP mechanisms; treatment strategies; and the importance of timely recognition, imaging guidance, and institutional preparedness.

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