Journal of the Chinese Medical Association
Volume 72, Issue 4 , Pages 207-209, April 2009

Catastrophic Complication of Stent Perforation in a Uremic Patient with Acute Myocardial Infarction

  • Chiu-Yang Lee

      Affiliations

    • Division of Cardiovascular Surgery, Department of Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chiu-Yang Lee, Division of Cardiovascular Surgery, Department of Surgery, Show-Chwan Memorial Hospital, 542, Section 1, Chung-Shang Road, Changhua 500, Taiwan, R.O.C.
    • ,
  • Yung-Zu Tseng

      Affiliations

    • Cardiovascular Section, Department of Internal Medicine, Show-Chwan Memorial Hospital, Changhua, Taiwan, R.O.C.

Received 13 August 2007; accepted 4 November 2008.

Article Outline

Catheter-induced coronary artery dissection is a rare but devastating complication of coronary angiography and percutaneous coronary intervention (PCI). Complications during PCI include coronary artery dissection, intramural hematoma, coronary artery perforation, and occlusion of branch vessels. Stent perforation is more unusual and potentially fatal. Here, we report a 68-year-old uremic woman who underwent primary PCI for her acute myocardial infarction. Unfortunately, dissection of the left proximal coronary artery by a guide catheter, followed by stent implantation, resulted in stent perforation through the middle left coronary artery and severe laceration of the left coronary orifice. Cardiogenic shock leading to cardiac arrest occurred. Emergency coronary artery bypass grafting and aortomy for left coronary orifice repair were conducted. The patient's postoperative course was uneventful, and she was discharged 15 days after surgery. From the successful outcome in this patient, we speculate that both better selection of patients and lesions for angioplasty and surgical standby may prove to be life-saving and effectively decrease subsequent mortality for patients experiencing devastating complications during PCI.

Key Words:  acute myocardial infarction (AMI) , coronary artery bypass grafting (CABG) , percutaneous coronary intervention (PCI)

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Gruentzig A . Transluminal dilation of coronary artery stenosis . Lancet . 1978;1:263
  2. Baim DS , Grossman W . Complications of cardiac catheterization . In:  Baim DS ,  Grossman W editor. Cardiac Catheterization, Angiography and Intervention . Baltimore: Williams & Wilkins; 1996;p. 17
  3. Stankovic G, Orlic D, Corvaja N, Airoldi F, Chieffo A, Spanos V, et al  Incidence, predictors, in-hospital, and late outcomes of coronary artery perforations . Am J Cardiol . 2004;93:213–216
  4. Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al  Increased coronary perforation in the new device era. Incidence, classification, management, and outcome . Circulation . 1994;90:2725–2730
  5. Gruberg L, Pinnow E, Flood R, Bonnet Y, Tebeica M, Waksman R, et al  Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention . Am J Cardiol . 2000;86:680–682
  6. Tsang TS , Freeman WK , Barnes ME , Reeder GS , Packer DL , Seward JB . Rescue echocardiographically guided pericardio-centesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience . J Am Coll Cardiol . 1998;32:1345–1350
  7. Seshadri N , Whitlow PL , Acharya N , Houghtaling P , Blackstone EH , Ellis SG . Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era . Circulation . 2002;106:2346–2350
  8. Yang EH , Gumina RJ , Lennon RJ , Holmes DR , Rihal CS , Singh M . Emergency coronary artery bypass surgery for percutaneous coronary interventions: changes in the incidence, clinical characteristics, and indications from 1979 to 2003 . J Am Coll Cardiol . 2005;46:2004–2009
  9. Hochberg MS , Gregory JJ , McCullough JN . Outcome of emergent coronary artery bypass following failed angioplasty . Circulation . 1990;82(Suppl):III–361
  10. Levy RD , Bennett DH , Brooks NH . Desirability of immediate surgical standby for coronary angioplasty . Br Heart J . 1991;65:68–71

PII: S1726-4901(09)70056-5

doi:10.1016/S1726-4901(09)70056-5

Journal of the Chinese Medical Association
Volume 72, Issue 4 , Pages 207-209, April 2009

Article Tools