How to treat emergency coronary perforation


Perforations can be life threating complications, but if recognised quickly and managed correctly can have a positive outcome. This section explains how to treat a coronary perforation.
In total there are 5 types.

PCR Complication Team: Patrick CalvertEric EeckhoutMichael HaudeAmir LermanOlivier Muller

Types of coronary perforation

There are five types of coronary perforation: Type I, Type II, Type III, Type IV and Type V. Type I and Type II are lower risk, but one needs to be particularly aware of the risk of progression to Type III. Type III and Type V are the most serious types of perforation where expedient treatment is crucial in order to save lives.


Extraluminal crater without jet extravasation

Type I

Type I coronary perforation


Pericardial or myocardial blushing without jet extravasation

Type II

Type II coronary perforation


Active jet extravasation exit jet > 1mm

Type III

Type III coronary perforation


Leaking into another cardiovascular cavity

Type IV

Type IV coronary perforation


Distal perforation

Type V

Type V coronary perforation

Each type of perforation is presented in four parts, namely:

  • Part 1 - Introduction
  • Part 2 - Management algorithm and additional links
  • Part 3 - Case library
  • Part 4 - Emergency management follow-up

In addition to this complication management resource, further cases on coronary perforation are available on the website in the Topics section on Other Coronary interventions.

A References page, is available at the end of this section if you would like to broaden your research. Please also consult the PCR-EAPCI Textbook, Part III - Chapter 24 on the Prevention and management of Complications during Percutaneous Coronary Intervention (PCI)


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Related files

EuroIntervention 2008 Aug;4(2):181-3