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).