Type III coronary perforation during chronic total occlusion percutaneous coronary interventions treated with Cyanoacrylate glue embolization: case report and review of the technique

Abstract

In recent times the outcome of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in dedicated centers has steadily gained high success rate (> 80%) and low rate of coronary complications. Nevertheless comparing with non-CTO PCI the complications rate is higher, due to the higher lesion and technical complexity. Among the complications Type III coronary perforations remain the most troublesome events of CTO PCI and still carry a significant risk of death for the patients. The management of Type III coronary perforations has been extensively described as a flow chart of interventions and techniques to obtain rapid cessation of the blood extravasation and sealing of the ruptured vessel. Several techniques have been described to obtain bleeding cessation also in small vessel (< 2 mm) perforations.In this paper we will describe two cases of CTO PCI with Type III small vessel coronary perforations treated with percutaneous Cyanoacrylate/(NBCA-MS)-based glue infusion through a conventional CTO microcatheter. This technique is fast and straightforward and can be applied to any conventional CTO microcatheter.

Keywords

Type III coronary perforations / coronary chronic total occlusion complication / cyanoacrylate/(NBCA-MS)-based glue

References

[1] Stone GW,Mehran R,Schwartz RS.Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I..Circulation2005;112:2364-72

[2] Sachdeva R,Flynn SE,Uretsky BF.The myocardium supplied by a chronic total occlusion is a persistently ischemic zone..Catheter Cardiovasc Interv2014;83:9-16

[3] Kahn JK.Angiographic suitability of catheter revascularization of total coronary occlusions in patients from a community hospital setting..Am Heart J1993;126:561-4

[4] Christofferson RD.Effect of chronic total coronary occlusion on treatment strategy..Am J Cardiol2005;95:1088-91

[5] Brilakis ES,Karmpaliotis D,Tsai TT.Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry)..JACC Cardiovasc Interv2015;8:245-53

[6] Kinnaird T,Kontopantelis E,Ludman P.Incidence, determinants, and outcomes of coronary perforation during percutaneous coronary intervention in the United Kingdom between 2006 and 2013: an analysis of 527 121 cases from the British Cardiovascular Intervention Society Database..Circ Cardiovasc Interv2016;9:e003449

[7] Ellis S.G.,Arnold A.Z..Increased coronary perforation in the new device era. Incidence, classification, management, and outcome..Circulation1994;90:2725-30

[8] Javaid A,Satler LF,Suddath WO.Management and outcomes of coronary artery perforation during percutaneous coronary intervention..Am J Cardiol2006;98:911-4

[9] Al-Lamee R,Latib A,Ferraro M.Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation..JACC Cardiovasc Interv2011;4:87-95

[10] Werner GS,Heinke S,Surber R.Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions..Circulation2003;107:1972-7

[11] Kilic ID,Serdoz R,Foin N.Coronary covered stents..EuroIntervention12:1288-95

[12] Hadjimiltiades S,Kazinakis G.Coronary vessel perforation during balloon angioplasty: a case report..Cathet Cardiovasc Diagn1998;45:417-20

[13] Komatsu I,Takimura H,Yamawaki M.A case of coronary artery perforation with successful hemostasis using over-the-wire balloon and autologous blood perfusion..Cardiovasc Interv Ther2013;28:197-201

[14] Dixon SR,Ormiston JA,Hammett CJ.Gelfoam embolization of a distal coronary artery guidewire perforation..Catheter Cardiovasc Interv2000;49:214-7

[15] Sto¨rger H.Closure of guide wire-induced coronary artery perforation with a two-component fibrin glue..Catheter Cardiovasc Interv2007;70:237-40

[16] Gaxiola E.Coronary artery perforation repair using microcoil embolization..Cathet Cardiovasc Diagn1998;43:474-6

[17] Albiero R,Corvaja N,Di Mario C.Left internal mammary artery graft perforation repair using polytetrafluoroethylene -covered stents..Cathet Cardiovasc Intervent2000;51:78-82

[18] Mahmud E.Coil embolization for successful treatment of perforation of chronically occluded proximal coronary artery..Cathet Cardiovasc Intervent2001;53:549-52

[19] Assali AR,Sdringola S,Smalling RW.Successful treatment of coronary artery perforation in an abciximab-treated patient by microcoil embolization..Catheter Cardiovasc Interv2000;51:487-9

[20] Aslam MS,Gilbert J.Successful management of coronary artery perforation with helical platinum microcoil embolization..Cathet Cardiovasc Intervent2000;51:320-2

[21] Dixon SR,Ormiston JA,Hammett CJK.Gelfoam embolization of a distal coronary artery guidewire perforation..Cathet Cardiovasc Intervent2000;49:214-7

[22] Yoo B,Lee SH,Lee HH.Guidewire-induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol foam..Cathet Cardiovasc Intervent2001;52:231-4

[23] Alfonso F,Herna´ndez R,Segovia J.Arterial perforation during optimization of coronary stents using high-pressure ballon inflations..Am J Cardiol1996;78:1169-72

[24] Teng MM,Lirng JF,Lee LS.N-butyl-2- (NBCA-MS)-based for embolization of carotid aneurysm..Neuroradiology1994;36:144-7

[25] Luo CB,Chang FC.Transarterial balloon-assisted n-butyl-2- (NBCA-MS)-based embolization of direct carotid cavernous fistulas..AJNR Am J Neuroradiol2006;27:1535-40

[26] Romero-Castro R,Jimenez-Saenz M,Caunedo-Alvarez A.EUS-Guided injection of (NBCA-MS)-based in perforating feeding veins of gastric varices: Results in 5 cases..Gastrointest Endosc2007;66:402-7

[27] Goel PK,Baijal SS,Agrawal SK.Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm..Indian Heart J2003;55:365-7

[28] Olivari Z,Piscione F,Fontanelli A.Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE)..J Am Coll Cardiol2003;41:1672-8

[29] Terashima M,Yaginuma GY,Kaneko U.Outcome of percutaneous intrapericardial fibrin-glue injection therapy for left ventricular free wall rupture secondary to acute myocardial infarction..Am J Cardiol2008;101:419-21

[30] Fujimatsu T,Takai F,Ogiwara F.Patch-and-glue sutureless repair for blowout rupture after myocardial infarction: report of 2 cases..Ann Thorac Cardiovasc Surg2008;14:48-51

[31] Goel PK.Delayed and repeated cardiac tamponade following microleak in RCA successfully treated with intra-arterial sterile glue injection..Catheter Cardiovasc Interv2009;73:797-800

[32] Gasparini GL,Mazzarotto P,Garbo R.Retrograde approach-related epicardial collateral channel perforation successfully treated with simultaneous bilateral coils embolization: a case illustration and review..Cardiovasc Revasc Med2018;19:879-86

[33] Hannah Hill,Anthony Hage.N-butyl cyanoacrylate embolotherapy: techniques, complications, and management..Diagn Interv Radiol.2018;24:98-103 PMCID:PMC5873510

[34] Kakaei F,Sanei B,Habibzadeh.A randomized clinical trial comparing the effect of different haemostatic agents for haemostasis of the liver after hepatic resection..HPB Surg2013;2013:587608 PMCID:PMC3789495

[35] Arvin R. Wali,David R. Santiago-Dieppa,James D. Murphy.Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis..Neurosurg Focus2017;42:E6 PMCID:PMC6369699