PCI COMPLICAIONSPCI COMPLICAIONS

BYDR Mohamed Ramadan, PhD

Consultant Intervention Cardiologist

STATISTICSSTATISTICS

Over 2 million PCI procedures worldwide

Angiographic success rate of 90-95%

Overall complication rate 1-5%

Successful PCISuccessful PCI

PCI performance is defined in terms of procedural success which identifies anatomical (or angiographic) success, (the enlargement of an epicardial vessel to a minimum luminal diameter of <10% stenosis or as near to 0% as possible, and TIMI 3 flow), without clinical complications

The assessment that takes place in order to judge the feasibility for PCI is essentially one based on a combination of individualized risk/benefit analysis, lesion/technical and patient/co-morbid characteristics

Aim: to identify those at highest risk

Patient clinical characteristics,Patient clinical characteristics,carrying increased riskcarrying increased risk

Advanced age Urgent or unscheduled intervention Hemodynamic instability Heart failure Renal insufficiency Diabetes mellitus Electrolyte imbalance Arrhythmia

Procedure complication categoryProcedure complication category

1. Death (related to the procedure, regardless of mechanism)

2. Stroke3. MI (related to the procedure, regardless of

mechanism)4. Ischemia requiring emergency CABG5. Vascular access site complication6. Contrast agent nephropathy7. Excessive bleeding, requiring treatment8. Other (such as coronary perforation and

tamponade)

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Complications from femoral Complications from femoral access for PCIaccess for PCI

Retroperitoneal hemorrhage Pseudo aneurysm AV fistula Infection Hematoma Neuropraxia Lower limb ischemia (thrombosis or

embolism) Dissection

Predictors of complications Predictors of complications relating to vascular accessrelating to vascular access

Female gender Advanced age Small body surface area Prior instrumentation Anticoagulation Peripheral vascular disease Diabetes Mellitus Suboptimal technique (puncture and closure)

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The aim should be to puncture the common femoral artery within a target zone , 5 mm to 14 mm inferior to the centre of the femoral head

LESION (ANGIOGRAPHIC) LESION (ANGIOGRAPHIC) CHARACTERISTICSCHARACTERISTICS

Calcification, tortuosity (angulation >45 degrees), left main, bifurcation subsets, degenerated saphenous vein graft, chronic total occlusion and multivessel disease all feature prominently in the diminished technical success of a procedure and the ability to be associated with complications

Coronary DissectionCoronary Dissection

Coronary dissection involves plaque fracture,intimal splitting and localized tear which mayextend to the media for varying distance

Left main artery dissection

Perforation is an anatomical breach in the integrity of the tunica adventitia of an epicardial artery leading to extravasation of blood, either into the myocardium, pericardium or a cardiac chamber

Coronary Perforation

After Balloon Inflation For more than 10 mins

Indications for emergency Indications for emergency cardiac surgery following PCIcardiac surgery following PCI

Extensive coronary dissection (54%) Perforation/tamponade (20%) Recurrent acute vessel closure (20%) Hemodynamic instability (3%) Aortic dissection (2%) Guide wire fracture (1%)

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How can you minimize PCI complications?