Intravascular ultrasound evidence of perivascular trauma during routine percutaneous coronary intervention.

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Citation: The International Journal of Cardiovascular Imaging. 30(5):849-56, 2014 Jun.PMID: 24728727Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Percutaneous Coronary Intervention/ae [Adverse Effects] | *Ultrasonography, Interventional | *Vascular System Injuries/et [Etiology] | *Vascular System Injuries/us [Ultrasonography] | Cardiovascular Diseases/su [Surgery] | Coronary Angiography | Female | Humans | Male | Middle Aged | Retrospective Studies | Treatment Outcome | Vascular System Injuries/ra [Radiography]Year: 2014ISSN:
  • 1569-5794
Name of journal: The international journal of cardiovascular imagingAbstract: We assessed whether intravascular ultrasound (IVUS) can detect evidence of coronary perforation that is not visible by coronary angiography. Approximately 15, 000 consecutive percutaneous coronary interventions (PCI) performed with IVUS guidance were reviewed retrospectively, pre- and post-PCI IVUS images were compared, and IVUS findings were compared with coronary angiography and in-hospital outcomes. We detected three distinct patterns that were not present pre-PCI and that were suggestive of perforation or perivascular trauma: perivascular blood speckle in 67 % (51/76), perivascular hematoma in 17 % (13/76), and new echolucent perivascular layer in 16 % (12/76). Angiographic appearance included perforation in 24 % (18/76), dissection in 33 % (25/76), lumen irregularity in 17 % (13/76), new stenosis in 5 % (4/76), and no abnormalities in 21 % (16/76). The site of a break in arterial wall with communication between the lumen and perivascular space could be detected in 61 % (46/76). This extended proximally and distally with equal frequency, but was primarily located within the lesion in 80 % (61/76), although the lumen was rarely compromised. Within 24 h, there were four emergent coronary artery bypass grafting procedures, one repeat PCI, and six periprocedural myocardial infarctions (defined as CK-MB >10 times the upper limit of normal), but there were no episodes of cardiac tamponade. Although infrequent, IVUS detected three distinct patterns of post-PCI perivascular trauma suggestive of a perforation that was detected angiographically in only 24 % of cases.All authors: Bui AB, Kent KM, Maehara A, Mintz GS, Pichard AD, Satler LF, Suddath WO, Waksman R, Weissman NJFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2015-03-17
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Journal Article MedStar Authors Catalog Article 24728727 Available 24728727

We assessed whether intravascular ultrasound (IVUS) can detect evidence of coronary perforation that is not visible by coronary angiography. Approximately 15, 000 consecutive percutaneous coronary interventions (PCI) performed with IVUS guidance were reviewed retrospectively, pre- and post-PCI IVUS images were compared, and IVUS findings were compared with coronary angiography and in-hospital outcomes. We detected three distinct patterns that were not present pre-PCI and that were suggestive of perforation or perivascular trauma: perivascular blood speckle in 67 % (51/76), perivascular hematoma in 17 % (13/76), and new echolucent perivascular layer in 16 % (12/76). Angiographic appearance included perforation in 24 % (18/76), dissection in 33 % (25/76), lumen irregularity in 17 % (13/76), new stenosis in 5 % (4/76), and no abnormalities in 21 % (16/76). The site of a break in arterial wall with communication between the lumen and perivascular space could be detected in 61 % (46/76). This extended proximally and distally with equal frequency, but was primarily located within the lesion in 80 % (61/76), although the lumen was rarely compromised. Within 24 h, there were four emergent coronary artery bypass grafting procedures, one repeat PCI, and six periprocedural myocardial infarctions (defined as CK-MB >10 times the upper limit of normal), but there were no episodes of cardiac tamponade. Although infrequent, IVUS detected three distinct patterns of post-PCI perivascular trauma suggestive of a perforation that was detected angiographically in only 24 % of cases.

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