A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of mid right coronary artery. In following echocardiogram after 12 days, the size of echogenic mass was decreased from 3.4 cmx2.6 cm to 1.7 cmx0.7 cm and we could conclude it was right coronary artery hematoma associated with PCI.

Clinical study of coronary artery perforation during percutaneous coronary interventions / 中国实用内科杂志

Objective To summarize clinical characteristics of coronary artery perforation during percutaneous coronary interventions.Methods Retrospective analysis of consecutive 32 patients who had coronary artery perforation in Fu Wai Hospital from April,2004 to August,2006 was carried out.Results Thirty-two cases of coronary perforation occurred during 7102 PCI procedures performed within this period(incidence:0.5%).These cases are comparatively complicated lesions including 81.3% of type B2+C and 62.5% of chronic total occlusion(CTO)lesions.Ellis classification:typeⅠ:14(43.8%),type Ⅱ:10(31.2%),type Ⅲ:8(25.0%),type Ⅳ:0.Mechanism of coronary artery perforation:guiding wire:21(65.6%),predilatation:6(18.8%),postdilatation:3(9.4%),stent implantation:2(6.2%).Clinical consequence:death:3(9.4%),cardiac temponade:7(21.9%),acute myocardial infarction(AMI):9(28.1%).Treatment:reversal of heparin-induced anticoagulation by application of protamine:14(43.8%),prolonged balloon inflation:9(28.1%),percardiocentesis:7(21.9%),implantation of membrane covered stent:4(12.5%),bail-out surgical repair:2(6.2%).Conclusion Coronary perforation during PCI is a rare complication;type Ⅲ perforation is associated with significant morbidity and mortality,which needs urgent and intensive treatment.

Guidewire-Induced Perforation of Distal Circumflex Artery Treated with Transcatheter Embolization of Polyvinyl Alcohol Form

Coronary artery perforation is a rare and serious complication in coronary angioplasty. Some patients complicated by coronary perforation may develop cardiac tamponade, which is generally due to massive hemorrhage in the pericardial space between the epicardium and the pericardium. We report a case of coronary artery perforation producing impending tamponade, which was successfully treated by transcatheter embolization of distal circumflex artery using polyvinyl alcohol.