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MSD Journal of Cardiology and Cardiovascular Medicine

Review Article       Open Access      Peer-Reviewed

Management of coronary artery perforation: A 2024 appraisal

Dr Debabrata Dash MD, DM, FICC, FAPSC, FSCAI, FCCP, FACC, FESC Aster Hospital, Al Mankhool, Kuwait Road, Dubai, UAE. Tel: +971552643546/+971 4 381 4800, Fax: +9714– 381 4814; Email: dr_dash2003@yahoo.com

Advances and innovations in technology have led to interventionists embarking on percutaneous coronary intervention in patients with increasingly complex anatomy, such as left main disease, heavily calcifi ed, multivessel disease, and chronic total occlusion. Consequently, the interventionist encounters an infrequent, yet potentially serious complication of coronary artery perforation (CAP). While the incidence of CAP is low, it can lead to severe consequences, such as cardiac tamponade, myocardial infarction, or even death. This review aims to provide an in-depth exploration of coronary perforation encompassing its epidemiology, pathophysiology, clinical presentation, contemporary therapeutic options, and future directions.

Keywords: Percutaneous coronary intervention; Perforation; Covered stent.

Introduction

Interventional cardiology remains a vigorous discipline with continued rapid evolution since its beginnings in the late 1970s. With the improvement of technology and interventional tools, interventionists have started embarking on percutaneous coronary intervention (PCI) in patients with increasingly complex anatomy, such as left main disease, heavily calci????ied, multivessel disease, and chronic total occlusion (CTO). Consequently, the interventionist is confronted with coronary artery perforation (CAP) which is a rare, yet potentially dreadful complication of PCI leading to severe consequences, such as cardiac tamponade, myocardial infarction, or even death. This review summarizes the available information about CAP and details the contemporary therapeutic options.

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