Introduction
Bifurcation lesions are complex lesions that remain among the most
challenging fields of treatment with percutaneous coronary intervention
(PCI). These lesions are associated with increased rates of procedural
complications, restenosis, and adverse events than lesions in the body
of the vessel (1). Following complex coronary interventions, there is a
relatively higher rate of complications, such as coronary dissection,
coronary perforation, acute coronary syndrome, and arrhythmias. (2)
Coronary perforations (CP) are rare complications of percutaneous
coronary intervention and can be classified as type I (extraluminal
crater), II (myocardial or pericardial blushing), and III (contrast
streaming or cavity spilling). Types I and II coronary perforations are
caused by stiff or hydrophilic guidewires. Type I has a benign
prognosis, whereas type II coronary perforations have the potential to
progress to tamponade. (2). The incidence of CP during PCI varies
between 0,12 and 0,82% (3,4,5) In a large database from British
Cardiovascular Intervention Society Database, coronary perforations were
more common in women or older, with a greater burden of comorbidity
including hypertension, hypercholesterolemia, previous myocardial
infarction, peripheral vascular disease, and left ventricular
dysfunction.
Coronary guidewire fracture is another rare complication of percutaneous
coronary intervention (PCI). Guidewire fracture could be due to:
entrapment into or behind stent struts, wire cutting by rotational
atherectomy devices, stuck wire into a distal tortuous vessel and
structural failure of the wire. Management options include retrieval by
snare or wire intertwining, deployment of the stent across broken
fragments, or leave the wire alone if it is in an insignificant distal
vessel or branch. (6)
Drug-eluting stent (DES) implantation using the ‘provisional’ approach
is the gold standard for percutaneous treatment of patients with
unselected bifurcated lesions, although some experts consider this
approach unsuitable for the treatment of more complex bifurcation
anatomies (7).