PCI procedure complication
- 1. PCI COMPLICAIONSPCI COMPLICAIONS BY DR Mohamed Ramadan, PhD Consultant Intervention Cardiologist
- 2. STATISTICSSTATISTICS Over 2 million PCI procedures worldwide Angiographic success rate of 90-95% Overall complication rate 1-5%
- 3. 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
- 4. 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
- 5. 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
- 6. Procedure complication categoryProcedure complication category 1. Death (related to the procedure, regardless of mechanism) 2. Stroke 3. MI (related to the procedure, regardless of mechanism) 4. Ischemia requiring emergency CABG 5. Vascular access site complication 6. Contrast agent nephropathy 7. Excessive bleeding, requiring treatment 8. Other (such as coronary perforation and tamponade)
- 10. Complications from femoralComplications from femoral access for PCIaccess for PCI Retroperitoneal hemorrhage Pseudo aneurysm AV fistula Infection Hematoma Neuropraxia Lower limb ischemia (thrombosis or embolism) Dissection
- 11. Predictors of complicationsPredictors 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)
- 12. ©2016EuropaDigital&Publishing.Allrightsreserved. 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
- 13. 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
- 15. Coronary DissectionCoronary Dissection Coronary dissection involves plaque fracture, intimal splitting and localized tear which may extend to the media for varying distance
- 17. Left main artery dissection
- 20. 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
- 31. After Balloon Inflation For more than 10 mins
- 35. Indications for emergencyIndications 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%)
- 37. ©2016EuropaDigital&Publishing.Allrightsreserved. How can you minimize PCI complications?