Outcome of prolonged balloon inflation for the management of coronary perforation

Background: Coronary perforation (CP) is a rare, sometimes lethal complication of percutaneous coronary intervention (PCI). Objectives: The purpose of this study was to review the cases of CP and to investigate the management after CP. Methods: A total of 3469 PCIs were performed in our institution from April 1999 to April 2008. All CP cases were identified from our computerized database. Results: Thirty patients were identified as having CP (0.86%). According to the Ellis classification, we determined the grade of perforation as type I in 17 cases (56%), type II in 2 cases (7%), and type III in 11 cases (37%). Most CPs were caused by wires (53%), while balloons, stents, and atherectomy devices were responsible for 7%, 37%, and 3%, respectively. Wire caused only 1 case of type III CP (6%), while stent caused 9 type III CPs (82%, p < 0.01). Four patients (36%) with type III CP required urgent coronary artery bypass graft surgery (CABG), while no patient with type I/II CP required it (p < 0.01). Prolonged balloon inflations were effective for 8 cases out of 11 stent CPs, however, the ballooning duration was significantly longer than that in wire and balloon CP (44 +/- 37 min vs. 21 +/- 13 min, p < 0.05). Conclusions: Stent CP often causes type III CP and one third of type III CP required urgent CABG. Although stent CP required longer balloon inflations for the management, prolonged balloon inflation might be useful for the management even in the stent CP. (c) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.