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An alternative treatment strategy for large vessel coronary perforations
Author(s) -
Xenogiannis Iosif,
Tajti Peter,
Nicholas Burke M.,
Brilakis Emmanouil S.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28034
Subject(s) - medicine , percutaneous coronary intervention , hemostasis , perforation , coronary occlusion , surgery , balloon , occlusion , coronary stent , stent , cardiology , radiology , myocardial infarction , restenosis , punching , materials science , metallurgy
The standard treatment for large vessel coronary perforations is implantation of a covered stent. Antegrade attempts for crossing a right coronary artery chronic total occlusion resulted in guidewire and microcatheter exit with pericardial bleeding. A balloon was inflated proximal to the perforation site to achieve temporary hemostasis. Retrograde crossing of the chronic total occlusion was achieved through an epicardial collateral using the reverse controlled antegrade and retrograde tracking technique. Stent implantation resulted in hemostasis, likely due to creation of a subintimal flap that sealed the perforation site. If technically feasible, subintimal recanalization can be an alternative treatment strategy for coronary perforations occurring during chronic total occlusion percutaneous coronary intervention.