Coronary stent implantation , which was once considered , a state of the art procedure is now practiced even in, remote towns and small nursing homes all over the world.
While , it is a blessing to have such a technology disseminate all over , we have also witnessed problems due to indiscriminate work ethics inside human coronary arteries. One of the deadly complication is coronary artery perforation.( It is not a surprise to experience this complication , especially when inexperienced, cardiologists try to manoeuvre fancy hardwares into the coronary artery for the first time !)
Ellis , fore- saw this yeas ago !
He classified coronary artery perforation into three types.
For type 3 perforation , the only emergency intervention is deploying a stent graft .
A covered stent with Polytetra fluro ethylene (PTFE)( Jostent ) is often used .
Final message
- Anticipate this complication , especially when negotiating CTOs and fragile venous grafts , or while dealing any complex lesion.
- Every cathlab should have a crash cart ready with anti perforation kit .( A large bore needle to tap tamponade is much more important than a PTFE stent graft !)
- Referring for an emergency surgery is one option , but it is often too late !
Dr.S.Venkatesan MD 