scholarly journals Coil Embolization for Coronary Artery Perforation: A Retrospective Analysis of 110 Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Daisuke Hachinohe ◽  
Yoshifumi Kashima ◽  
Yuito Okada ◽  
Daitaro Kanno ◽  
Ken Kobayashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Function ◽  
Coil Embolization ◽  
Myocardial Damage ◽  
Chronic Total Occlusions ◽  
Coronary Artery Perforation ◽  
Main Vessel ◽  
Collateral Channel ◽  
Almost All ◽  
Type V

Objective. Coil embolization (CE) for coronary artery perforation (CAP) has not been thoroughly evaluated. This study aimed to evaluate the extent of myocardial damage and impact on cardiac function after CE for CAP. Methods. A total of 110 consecutive patients treated with CE for CAP were retrospectively identified. The degree of myocardial damage and impact on cardiac function were evaluated. Results. Forty-nine (44.5%) cases involved chronic total occlusions. A guidewire was the cause of perforation in 97 (88.2%) patients. The success rate of CE was 98.2%. Almost all patients were prescribed either antiplatelet drugs or anticoagulant medication or both. Patients with perforation types III and IV were found to be prone to creatinine kinase (CK) elevation and epicardial main vessel perforation, thereby causing myocardial damage. No changes were noted in the ejection fraction (EF) in patients with type V distal perforation and collateral channel perforation, while patients with perforation of the epicardial main vessel may show impaired cardiac function afterward. Conclusions. CE is safe and effective for treating CAP, especially when collateral channels and distal vessels are involved. Meanwhile, efforts should be taken to prevent CAP in epicardial main vessels since it may be difficult to treat with CS and cause myocardial damage when bailed out with CE leading to vessel sacrifice. We found that it was not necessary to change the anticoagulant regimen after CE owing to its ability to achieve robust hemostasis.

Abstract 12850: Isolated and Assisted Transcatheter Coil Embolization of Coronary Artery Lesions: The Cleveland Clinic Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Omar M Abdelfattah ◽  
Anas M Saad ◽  
Nicholas Kassis ◽  
Shashank Shekhar ◽  
Toshiaki Isogai ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coil Embolization ◽  
Cleveland Clinic ◽  
Artery Aneurysm ◽  
Side Branch ◽  
Coronary Artery Lesions ◽  
Vascular Plug ◽  
Artery Pseudoaneurysm ◽  
Coronary Artery Perforation ◽  
Transcatheter Coil Embolization

Introduction: Transcatheter coil embolization (TCE) has been introduced as a modality in treating several coronary artery lesions including coronary artery fistula (CAF), patent left internal mammary artery (LIMA) side branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) is limited. Hypothesis: TCE is underutilized in various coronary lesions despite its efficacy. Methods: This is a retrospective, descriptive study of all adult patients who underwent TCE at the Cleveland Clinic between August 2007 and August 2019. A total of 41 patients, including 25 CAF, 7 patent LIMA side branches, 5 CAP, 2 CAA, and 2 CAPA from a total of 121,196 cases, were studied. Results: Successful angiographic closure was performed in 37 out of 41 (90%) cases (100% ,100% ,100%, 88%, 80%, of patent LIMA side branch ,CAA, CAPA, CAF, CAP, respectively). Ampatzer vascular plug was used as an adjunctive device in 10% of the total cohort. No adverse events were directly associated with TCE among the LIMA, CAA, and CAPA lesions, and only one patient with CAF required re-intervention at three months due to coil migration. One patient with a large CAP of the mid-left anterior descending artery died while hospitalized due to cardiogenic shock despite successful embolization. Conclusions: Transcatheter Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with successful angiographic results in 90% of treated cases. Additional study on the utilization of vascular plug devices in cases such as LIMA side branch or CAF would be beneficial to better understand the treatment options.

scholarly journals Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daisuke Kanda ◽  
Takuro Takumi ◽  
Takeshi Sonoda ◽  
Ryo Arikawa ◽  
Kazuhiro Anzaki ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Tamponade ◽  
Coil Embolization ◽  
Inferior Wall ◽  
Vessel Sealing ◽  
Coronary Artery Perforation ◽  
Contrast Enhanced ◽  
Transcatheter Coil Embolization ◽  
The Right ◽  
Enhanced Computed Tomography

Abstract Background Pericardiocentesis is frequently performed when fluid needs to be removed from the pericardial sac, for both therapeutic and diagnostic purposes, however, it can still be a high-risk procedure in inexperienced hands and/or an emergent setting. Case presentation A 78-year-old male made an emergency call complaining of the back pain. When the ambulance crew arrived at his home, he was in a state of shock due to cardiac tamponade diagnosed by portable echocardiography. The pericardiocentesis was performed using a puncture needle on site, and the patient was immediately transferred to our hospital by helicopter. Contrast-enhanced computed tomography showed a small protrusion of contrast media on the inferior wall of the left ventricle, suggesting cardiac rupture due to acute myocardial infarction. Emergency coronary angiography was then performed, which confirmed occlusion of the posterior descending branch of the left circumflex coronary artery. In addition, extravasation of contrast medium due to coronary artery perforation was observed in the acute marginal branch of the right coronary artery. We considered that coronary artery perforation had occurred as a complication of the pericardial puncture. We therefore performed transcatheter coil embolization of the perforated branch, and angiography confirmed immediate vessel sealing and hemostasis. After the procedure, the patient made steady progress without a further increase in pericardial effusion, and was discharged on the 50th day after admission. Conclusions When performing pericardial drainage, it is important that the physician recognizes the correct procedure and complications of pericardiocentesis, and endeavors to minimize the occurrence of serious complications. As with the patient presented, coil embolization is an effective treatment for distal coronary artery perforation caused by pericardiocentesis.

Coronary artery perforation following pericardiocentesis managed by coil embolization

2009 ◽  
Vol 70 (2) ◽  
pp. e57-e59 ◽  
Author(s):  
Edward W. Lee ◽  
Raymond Hung ◽  
Stephen T. Kee ◽  
Marjan S. Bolouri ◽  
Christopher T. Loh
Keyword(s):  
Coronary Artery ◽  
Coil Embolization ◽  
Coronary Artery Perforation

Side branch FFR after provisional stenting: simplified approach based on OCT frame count

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kini ◽  
N Okamoto ◽  
N Barman ◽  
Y Vengrenyuk ◽  
K Yasumura ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Functional Significance ◽  
Area Under The Curve ◽  
Side Branch ◽  
Funding Source ◽  
Fractional Flow ◽  
Simplified Approach ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Abstract Background/Introduction Treatment of bifurcation coronary artery lesions remains a major challenge in interventional cardiology. Side branch (SB) stenoses are frequently observed after stent implantation in bifurcation lesions, although angiographically narrowed SBs may not be functionally significant. Fractional flow reserve (FFR), a pressure-derived index of the hemodynamic significance of a coronary artery stenosis, may be useful in determining whether additional intervention is required in jailed SBs. Angiography and intravascular ultrasound (IVUS) derived parameters have showed poor diagnostic accuracy in predicting the functional significance of jailed SBs. Purpose The aim of the present study was to use high resolution optical coherence tomography (OCT) imaging to predict functionally significant SB stenoses after provisional stenting defined as SB FFR ≤0.80. Methods Seventy-one patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses undergoing provisional stenting were enrolled in the prospective study. OCT pullbacks were performed before and after stent placement, and SB FFR was measured after main vessel stenting. SB ostium area (SBOA) was assessed using three-dimensional OCT cut-plane analysis off-line. In addition, we developed a simplified approach to SB ostium assessment based on SB ostium frame count using two-dimensional OCT pullback not requiring off-line 3D reconstruction. For the analysis, consecutive frames were counted between the most distal and most proximal take-off of the SB frames. Results Similar to previous studies, quantitative coronary angiography findings were not associated with the functional significance of SBs after main vessel stenting. In contrast, SBOA assessed by 3D-OCT after provisional stenting strongly correlated with post-procedure SB FFR. The optimal cut-off value for the SBOA area to predict a SB FFR ≤0.80 was 0.76 mm2 (sensitivity 82%, specificity 89% and area under the curve of 0.92 (95% CI: 0.84–0.99). A simplified approach to SB ostium assessment using OCT frame count yielded a sensitivity of 82%, specificity 89% and area under the curve 0.92 (95% CI: 0.84 to 0.99) with a cut-off of 4.5 frames allowing detection of functionally significant SB stenoses during the procedure in real time. Figure 1 shows a receiver-operating characteristic curve for SB FFR ≤0.8 and a representative case with SB FFR = 0.66 after provisional stenting and SB ostium frame count equal 3 (Frame 1 to 3) Conclusion(s) Assessment of SB using either 3D OCT off-line reconstruction or a simplified approach based on OCT frame count can detect SB branches with FFR ≤0.80 with high sensitivity and specificity. The developed approaches may represent a useful tool to assess provisional stent outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific; St. Jude Medical

scholarly journals Endothelial β1 Integrin-Mediated Adaptation to Myocardial Ischemia

2021 ◽  
Author(s):  
Carina Henning ◽  
Anna Branopolski ◽  
Paula Follert ◽  
Oksana Lewandowska ◽  
Aysel Ayhan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Cardiac Function ◽  
Integrin Subunit ◽  
Β1 Integrin ◽  
Human Coronary Artery ◽  
Tetrazolium Chloride ◽  
Magnetic Resonance Imaging Mri ◽  
Interfering Rna

Abstract Background Short episodes of myocardial ischemia can protect from myocardial infarction. However, the role of endothelial β1 integrin in these cardioprotective ischemic events is largely unknown. Objective In this study we investigated whether endothelial β1 integrin is required for cardiac adaptation to ischemia and protection from myocardial infarction. Methods Here we introduced transient and permanent left anterior descending artery (LAD) occlusions in mice. We inhibited β1 integrin by intravenous injection of function-blocking antibodies and tamoxifen-induced endothelial cell (EC)-specific deletion of Itgb1. Furthermore, human ITGB1 was silenced in primary human coronary artery ECs using small interfering RNA. We analyzed the numbers of proliferating ECs and arterioles by immunohistochemistry, determined infarct size by magnetic resonance imaging (MRI) and triphenyl tetrazolium chloride staining, and analyzed cardiac function by MRI and echocardiography. Results Transient LAD occlusions were found to increase EC proliferation and arteriole formation in the entire myocardium. These effects required β1 integrin on ECs, except for arteriole formation in the ischemic part of the myocardium. Furthermore, this integrin subunit was also relevant for basal and mechanically induced proliferation of human coronary artery ECs. Notably, β1 integrin was needed for cardioprotection induced by transient LAD occlusions, and the absence of endothelial β1 integrin resulted in impaired growth of blood vessels into the infarcted myocardium and reduced cardiac function after permanent LAD occlusion. Conclusion We showed that endothelial β1 integrin is required for adaptation of the heart to cardiac ischemia and protection from myocardial infarction.

Sign in / Sign up

Export Citation Format

Share Document