Perforation

Coronary perforations have traditionally been classified according to severity using the Ellis classification. In addition to severity, another key classification of coronary perforations is according to location, as location has important implications regarding management. There are three main perforation locations: (1) large vessel perforation, (2) distal vessel perforation, and (3) collateral vessel perforation, in either a septal or an epicardial collateral. In this chapter a stepwise approach to coronary perforations is presented, including general measures (inflation of a balloon to stop the bleeding, intravenous fluid and vasopressor administration, pericardiocentesis, and cardiac surgery notification) and type-specific measures (large vessel perforations are usually treated with a covered stent, whereas distal vessel and collateral vessel perforations are usually treated with embolization using fat or coils).