What is the medical term for perforation of Percutaneous Coronary Intervention (PCI)?

From the Guidelines

The medical name for perforation during percutaneous coronary intervention (PCI) is coronary artery perforation (CAP). This is a rare but serious complication that occurs when the guidewire, balloon, stent, or other device used during PCI creates a tear in the coronary artery wall. Coronary perforations are classified using the Ellis classification system, ranging from Type I (extraluminal crater without extravasation) to Type III (extravasation through a frank perforation ≥1 mm with contrast streaming) 1. Management depends on the severity and may include prolonged balloon inflation at the perforation site, reversal of anticoagulation, covered stent placement, or emergency surgery in severe cases. Pericardiocentesis may be needed if cardiac tamponade develops from blood accumulating in the pericardial space. The risk of perforation is higher in complex lesions, calcified vessels, chronic total occlusions, and when using aggressive devices like rotational atherectomy.

Key Points

• The Ellis classification system is used to classify coronary perforations, with Type III being the most severe 1.
• Management of coronary perforation depends on the severity of the perforation and may include prolonged balloon inflation, reversal of anticoagulation, covered stent placement, or emergency surgery 1.
• Prompt recognition and management of coronary perforation are essential to prevent complications such as cardiac tamponade, myocardial infarction, or death 1.
• The definition of perforation, type III, is extravasation through frank (>1 mm) perforation, as defined by the American College of Cardiology/American Heart Association task force on clinical data standards 1.

From the Research

Medical Name for Perforation of PCI

The medical name for perforation of PCI (Percutaneous Coronary Intervention) is coronary perforation or coronary artery perforation.

Definition and Classification

• Coronary perforation is a serious complication of PCI, where there is a tear or hole in the coronary artery wall 2, 3, 4, 5, 6.
• It can be classified into different types, including Type 1,2, and 3, based on the severity of the perforation 4.

Causes of Coronary Perforation

• The causes of coronary perforation include:
  • Wire manipulation, particularly with hydrophilic and stiff wires 3, 4.
  • Stent deployment and post-dilatation 2, 3, 5.
  • Use of debulking devices, such as atherectomy devices 2, 6.
  • Guidewire exit, particularly in distal vessel perforations 5.

Management and Outcomes

• The management of coronary perforation depends on the severity and type of perforation, and may include:
  • Long inflation of a balloon to seal the perforation 2.
  • Implantation of a covered stent graft 2, 3, 5.
  • Emergency surgical repair, such as coronary artery bypass grafting (CABG) 2, 3, 6.
• The outcomes of coronary perforation can be severe, with high rates of morbidity and mortality, including cardiac tamponade, myocardial infarction, and death 2, 3, 5, 6.