Link 6: Coronary perforation treatment autologous subcutaneous fat embolisation

Complications: Coronary perforation

Let's take a look at the treatment specific to autologous subcutaneous fat embolisation and subcutaneous fat embolisation.

Autologous subcutaneous fat embolisation:

• For distal guidewire perforation
• Physical barrier to bleeding
• Coagulation activator
• Simple, low-cost and universally available treatment
• Allow for a subsequent PCI attempt

Subcutaneous fat embolisation:

• Fat from abdominal or femoral (next to the puncture point) subcutaneous tissue:
  • Local anaesthesia
• Fat globules small enough to be delivered throughout a thrombo-aspiration catheter ≤1mm if 6Fr, ≤ 1.2mm if 7Fr, a microcatheter or a OTW balloon:
  • Pushed by a wire
  • Or "emulsion" with saline serum injection
• Catheter positioned just close to the perforation to avoid:
  • Large peri-procedural infarction by embolisation into branches
  • Systemic or cerebral embolisation

References

1. Oda et al Catheterization and Cardiovascular Interventions 2005
2. George et al Catheterization and Cardiovascular Interventions 2015
3. Shemisha et al Catheterization and Cardiovascular Interventions 2016

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