Complications of chronic total occlusion percutaneous coronary intervention
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Neth Heart J https://doi.org/10.1007/s12471-020-01502-1
Complications of chronic total occlusion percutaneous coronary intervention J. Karacsonyi · E. Vemmou · I. D. Nikolakopoulos · I. Ungi · B. V. Rangan · E. S. Brilakis
Accepted: 30 September 2020 © The Author(s) 2020
Abstract Chronic total occlusion percutaneous coronary interventions can be highly complex and are associated with an increased risk of complications, such as perforation, acute vessel closure (which can lead to rapid haemodynamic compromise if it involves the donor vessel), and equipment loss or entrapment. Awareness of the potential complications and meticulous attention to equipment position and patient monitoring can help minimise the risk of complications and allow prompt treatment should they occur. Keywords Complication · Percutaneous coronary intervention · Chronic total occlusion
Introduction Despite its clinical benefits [1, 2] chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with higher complication rates than PCI of non-occlusive lesions [3]. CTO PCI complications include death, acute myocardial infarction, stroke, the need for repeat PCI, emergency coronary artery bypass graft surgery, tamponade requiring pericardiocentesis or surgery, acute vessel closure (which can be a catastrophic complication if it involves the CTO donor vessel), coronary dissection, aorto-ostial dissection, thrombus, embolisation of thrombus, J. Karacsonyi · E. Vemmou · I. D. Nikolakopoulos · B. V. Rangan · E. S. Brilakis () Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA [email protected] J. Karacsonyi · I. Ungi Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
plaque or air, side branch occlusion, spasm, pseudolesion formation, intramural haematoma, perforation, equipment entrapment/loss, hypotension, arrhythmias, vascular access complications and bleeding, contrast-induced acute kidney injury, and radiation skin injury [4]. The complications of CTO PCI can be classified as acute and long-term based on timing. CTO PCI complications can also be classified according to location into cardiac and non-cardiac complications. Cardiac complications can be further divided into coronary and non-coronary (Tab. 1). Each complication has a different mechanism and underlying causes. A score has been developed for estimating the risk of periprocedural complications using the following three parameters: patient age >65 years, +3 points; lesion length ≥23 mm, +2 points; and use of the retrograde approach, +1 point [5].
Donor vessel injury Donor vessel injury requires immediate identification and management, as it can lead to extensive ischaemia and haemodynamic decompensation [6]. In a meta-analysis of retrograde CTO PCIs, donor vessel dissection occurred in 2% of treated CTOs (95% confidence interval: 0.9–4.5%) [7]. Donor vessel injury may be due to dissection caused by deep ca
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