Hope for the best, prepare for the worst: How to manage coronary perforations

The incidence of coronary perforation in a contemporary cohort of 13,339 PCI procedures was 0.51%. The majority (75%) were large-vessel perforations Although only 1 patient required emergency cardiac surgery, in-hospital mortality was high (10%) Given the infrequent occurrence of coronary perforations, uniform recommendations for its management are lacking. Nonetheless, the present study suggests that avoiding oversized balloons or stents might potentially reduce the incidence of perforations.