CORONARY PERFORATIONS

Abstract

A perforation is an infrequent but life-threatening complication of all percutaneous coronary intervention, with a risk estimated between 0.1-3% of all procedures. Despite the higher probability of occurrence in more complex procedures, like the treatment of CTO lesions, or during rotational atherectomy, the fatal evolution could be higher in the easier procedures, because is often not expected and the operator not enough trained. Therefore, all interventional cardiologists, even beginners, must keep in mind prevention strategies and the management algorithm, together with the specific features of the devices available in their own Cath-lab. Inflate a balloon to transitory stop the bleeding, perform a pericardiocentesis of a large effusion and deploy a covered stent or a coil are not technically demanding procedures if the operator is prepared, event at the first time. The following chapter gives an overview on this topic starting from the definition and the recently updated Ellis classification, describing pathophysiology and prevention strategies, and explaining management strategies.