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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015
e6
AFRICA
vessel lumen was too small. Although it was concluded that the
ventricle had been penetrated, for safety reasons, we carried out
a block by coil embolisation. We did not use a gelatin sponge
because of the risk of pulmonary embolism.
The long- and short-term safety and effectiveness of coil
embolisation are good, but it might be not the best choice in
all cases. If perforation does involve the right ventricle, close
monitoring without any treatment may be beneficial for the
patient because of reduction in myocardial cell necrosis.
We did not use glycoprotein IIb/IIIa inhibitors during
treatment, therefore the question of discontinuation did not
arise. The data show that the more patients who were given
a glycoprotein IIb/IIIa inhibitor required the placement of a
covered stent or emergency cardiac surgery than those who did
not receive it (33.3 vs 3.2%). Clinical outcomes (tamponade,
myocardial infarction, death) were similar for patients who had
and had not received a glycoprotein IIb/IIIa inhibitor.
8
Reversal of heparin was considered in our case but was not
adopted because of the risk of coronary thrombosis and the
patient’s haemodynamic stability. Al-Lamee
et al
. recommend
the use of protamine ‘as necessary’ in the setting of coronary
perforation if heparin or glycoprotein inhibitors have been
administered.
22
Conclusion
Coronary artery perforation is a rare but dreaded complication
of PCI. Coronary perforation of the right ventricular cavity
is less severe than perforation at other sites. Although coil
embolisation is a safe and effective alternative to balloon
treatment of coronary artery perforation, it might be not the best
choice in the short and long term. If the perforation does break
through into the right ventricle, we suggest close monitoring
rather than treatment, which may be beneficial for patients in
that it reduces the risk of myocardial cell necrosis.
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