Tejas Patel, MD | Sanjay Shah, MD | Samir B. Pancholy, MD

Chapter 2: Coronary Artery Perforations

Coronary artery perforation is an infrequent but potentially life-threatening complication during percutaneous coronary intervention (PCI).1-8 It is one of the most challenging complications faced by an interventional cardiologist in the catheterization laboratory and has repeatedly been shown to be associated with poorer outcomes, including myocardial infarction (MI), emergency coronary artery bypass surgery (CABG), and death.1-11 Fortunately, the incidence of coronary artery perforation remains low, with a range of 0.1% to 0.5%, and appears to be decreasing over past two decades.12,13 Nonetheless, catastrophic perforation continues to occur and is currently instrumental for about 20% of cases referred for emergency CABG.3,5-10,14 Every interventional cardiologist should be familiar with strategies and hardware used to manage this potentially lethal complication, with the goals of avoiding emergency surgery, maintaining coronary and systemic perfusion, and minimizing myocardial damage.

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