PT  - JOURNAL ARTICLE
AU  - Debabrata Dash
TI  - Complications of coronary intervention: abrupt closure, dissection, perforation
AID  - 10.1136/heartasia-2013-010304
DP  - 2013 Jan 01
TA  - Heart Asia
PG  - 61--65
VI  - 5
IP  - 1
4099  - http://heartasia.bmj.com/content/5/1/61.short
4100  - http://heartasia.bmj.com/content/5/1/61.full
AB  - The introduction of drug-eluting stents (DESs) and superior anticoagulation has successfully improved the safety and patency rates of complex percutaneous coronary interventions (PCIs). The evolving techniques of contemporary PCI have been unable to completely eliminate coronary injury and mechanical complications. Primary causes for abrupt closure include dissection, thrombus formation and acute stent thrombosis. Initial treatment for abrupt closure includes balloon redilatation, optimisation of activated clotting time (ACT) and deployment of stent to stabilise a dissection. Coronary perforation is one of the most challenging and feared complications of PCI. It is most frequently due to distal wire or balloon/stent oversizing and should be fixed with balloon occlusion. Covered stent may be needed for large perforation in major proximal vessels. Perforations in small or distal vessels not resolving with balloon occlusion may be managed by coil or Gelfoam embolisation. Referral to emergency coronary artery bypass surgery (CABG) should be an option in case perforations do not seal.