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DOI: 10.1055/s-0032-1325078
Komplikationsmanagement bei perkutaner Koronarintervention (PCI)
Complication Management during Percutaneous Coronary InterventionPublikationsverlauf
Publikationsdatum:
19. August 2013 (online)
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Zusammenfassung
Schwere Komplikationen treten in weniger als 2 % aller Koronarinterventionen auf. Alle Komplikationen sollten im Team interventionell beherrscht werden, um eine Hoch-Risiko-Notfallbypassoperation zu umgehen. Flussrelevante Koronardissektionen werden mit weiteren Stents, die Stentthrombose mittels IVUS-geführter Hochdruckdilatation, ggf. Upsizing des Stents und Optimierung der antithrombozytären Therapie behandelt. Bei akuter Koronarperforation ist die sofortige Perikardpunktion, Antagonisierung des Heparins und eine Langzeitokklusion des Zielgefäßes indiziert. Kommt die Blutung nicht zum Stehen werden zentrale Perforationen mit Graft Stents und periphere, drahtbedingte Komplikationen mit Coilembolisation therapiert. Im Falle eines No-Reflow ist die intrakoronare Gabe von Adenosin oder Kalziumantagonisten hilfreich.
Abstract
Severe coronary complications occur in less than 2 % of all percutaneous coronary interventions (PCIs). All complications should be managed using interventional techniques and a team approach in order to avoid high-risk emergency bypass surgery. Flow-limitating coronary dissections are managed by additional stenting, coronary stent thrombosis by IVUS guided high pressure dilatation, upsizing of the stent and optimization of antiplatelet therapy. Coronary perforation is handled by pericardiocentesis, reversal of anticoagulation and longterm dilatation followed by graft stent implantation for central rupture of coronary arteries and by coil embolization for peripheral wire induced perforations. No-reflow can be treated by intracoronary adenosis or calcium antagonists.
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