Coronary Artery Dissection and Perforation
Coronary artery dissection remains a common occurrence during PCI but clinical sequelae have been minimized by the routine use of coronary stents. Perforation, although rare, can often be a life-threatening complication. Rapid recognition and attention to the angiographic appearance of the perforation is essential to the successful management of this complication. As outlined, those perforations which are "contained" angiographically carry a more benign prognosis that those which are freely extravasating contrast into the pericardium. Treatment should be aimed at sealing the perforation with prolonged conventional or perfusion balloon inflation, prudent reversal of anticoagulation and use of covered stents. Echocardiography should be performed in all cases of coronary perforation and emergent pericardiocentesis if tamponade develops. In cases where sealing of the perforation by conservative measures cannot be achieved, urgent bypass surgery must be performed.
Coronary artery dissection remains a common occurrence during PCI but clinical sequelae have been minimized by the routine use of coronary stents. Perforation, although rare, can often be a life-threatening complication. Rapid recognition and attention to the angiographic appearance of the perforation is essential to the successful management of this complication. As outlined, those perforations which are "contained" angiographically carry a more benign prognosis that those which are freely extravasating contrast into the pericardium. Treatment should be aimed at sealing the perforation with prolonged conventional or perfusion balloon inflation, prudent reversal of anticoagulation and use of covered stents. Echocardiography should be performed in all cases of coronary perforation and emergent pericardiocentesis if tamponade develops. In cases where sealing of the perforation by conservative measures cannot be achieved, urgent bypass surgery must be performed.
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