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PERFORATION
Miftahul Afandi, MD
RSUD AM Parikesit Tenggarong Kutai Kartanegara,
Kalimantan Timur
Fellowship Interventional Cardiology,
RSUD Dr Soetomo Surabaya
DISCLOSURE STATEMENT OF FINANCIAL
INTEREST
Ischemic Events
Stent Misadventures
Aortic Injury
Coronary Perforation
BACKGROUND
Coronary Artery Perforation (CAP) is a rare
The Incidence of CAP 0.8 % of PCI case
Potentially life-threatening complication of (PCI)
www.medscape.com
Algoritme penanganan diseksi dan
perforasi arteri koroner
CASE REPORT 1
Mr. EMR, 58 y.o
Chief complaint :
stable angina
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
Angiography : CTO in pLAD; stenosis 75% and 70% at
proximal & distal LCx; RCA : stented vessel without any
significant restenosis
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
RCA
Percutaneous Coronary Intervention (PCI)
SUCCEED
CTO in LAD :
Guidewire (GW) Fielder FC GW
Conquest Pro supported by microcatheter
Finecross
Guiding catheter (GC) BL
3.5 7F to LMCA
CTO in LAD :
Guidewire (GW) Fielder
FC GW Conquest Pro
supported by
microcatheter Finecross
D1 branch
perforation
(Ellis Type 3)
What should we do?
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
JOHN DOE, MD
SUBTITLE 32 PT ARIAL BOLD ITALICS
CTO in LAD :
Guidewire (GW) Asahi
Fielder XT 0.36 mm
GW Miracle 12
Guiding catheter (GC) SUCCEED !
Hearttrail II BL 3.5 7F to LMCA
Percutaneous Coronary Intervention (PCI)
JOHN DOE, MD
Guiding catheter
SUBTITLE 32(GC) Hearttrail
PT ARIAL II BL
BOLD ITALICS D1 branch
3.5 7F to LMCA coronary
perforation
CTO in LAD : (Ellis Type III with
Guidewire (GW) Asahi Fielder XT 0.36 cavity spilling)
mm GW Miracle 12
Percutaneous Coronary Intervention (PCI)
D1 branch coronary
perforation
(Ellis Type III with cavity spilling)
GW was withdrew
Rewiring
Prolonged Balloon
Inflation
(5-10 minutes)
Percutaneous Coronary Intervention (PCI)
Prolonged Balloon
Inflation
(5-10 minutes
Prolonged Balloon
Inflation
(5-10 minutes
stent placement
at the site of the
perforation
Percutaneous Coronary Intervention (PCI)
stent placement
at the site of the
perforation