ArticleJACC. Case reports2026
Management of Coronary Artery Perforations: A Stepwise, Case-Based Review From a High-Volume Center.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundCoronary artery perforation (CAP) is an uncommon but potentially life-threatening complication of percutaneous coronary intervention, occurring in 0.2% to 0.5% of routine cases and up to 3% of complex procedures such as chronic total occlusion interventions. CASE SUMMARY: We report 9 consecutive cases of CAP managed at a high-volume tertiary center in the United Kingdom and involving varied coronary territories, mechanisms, and Ellis grades (I-V). All cases were initially managed with balloon tamponade. Definitive treatments included covered stents (n = 4), coil embolization (n = 2), and autologous clot embolization (n = 1), with no surgical bailout. Ellis class III perforations accounted for 4 cases, all requiring active intervention. Pericardial effusion occurred in 5 patients, with 3 patients requiring urgent pericardiocentesis. No in-hospital mortality was observed. DISCUSSION: CAP management should be guided by the severity of perforation, the anatomical site, and the patient's hemodynamics. A structured algorithm involving early balloon tamponade, lesion-specific device selection, and structured escalation can prevent mortality and surgical bailout.
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