Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation

Rasha Al-Lamee, Alfonso Ielasi, Azeem Latib, Cosmo Godino, Massimo Ferraro, Marco Mussardo, Francesco Arioli, Mauro Carlino, Matteo Montorfano, Alaide Chieffo, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

150 Scopus citations


Objectives The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention. Background Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality. Methods From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation. Results Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%. Conclusions Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates.

Original languageEnglish (US)
Pages (from-to)87-95
Number of pages9
JournalJACC: Cardiovascular Interventions
Issue number1
StatePublished - Jan 2011
Externally publishedYes


  • coronary intervention
  • coronary perforation
  • management
  • percutaneous

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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