Acute and long‐term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3‐CAP registry

Abstract

Background: Covered stent (CS) implantation is considered a useful device in the setting of Grade III Coronary Perforation (G3CP), one of the most harmful PCI complication. However, data regarding efficacy of this device and clinical outcomes are still limited. Methods and results: From 1993 to 2015, among 97,779 patients from 9 European centres undergoing PCI, 224 patients had G3CP (0.23%), and 102 patients were managed with CS implantation (96 with PTFE, 6 with pericardium). Device oriented composite endpoint (DOCE), a composite of cardiac death, target lesion revascularization, and stent thrombosis (ST) in-hospital and at long term follow-up were evaluated. G3-CP perforations were successfully sealed with CS in 88 patients (86.3%) with need of intraprocedural pericardiocentesis in one-third of cases.Protamine as heparin reversal agent was administered in 36 (35%) of cases. The cumulative incidence of in-hospital DOCE were 16.6% (17/102): death 14.7%, TLR 2.9%, ST 3.9%. At longterm follow-up (mean 42 AE 38 months), DOCE rates occurred in 19.7%: death 7.4%, TLR 11%, and ST 6.2%. Indication to Dual Antiplatelet Therapy (DAPT) was lifelong in 20% of cases, 1 to 6 months in 22.5% and 12-months in 57.5% without differences in long-term DOCE before and after DAPT interruption (8.0 vs. 6.6%, respectively, P = 0.20).Conclusions: Use of CS was successful in sealing grade 3 coronary artery perforations in the majority of cases. Beside the high rate of clinical events at short and long-term, ST remains the leading cause of device failure. K E Y W O R D Saneurysm/dissection/perforation, complications, CORD-coronary, coronary artery disease, percutaneous coronary intervention, stent fracture/failure, stent thrombosis

“Burying” covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency

“…during short-and long-term follow-up (> 12 months), our results implicate that better outcomes (TLF rate < 5%) might be achieved after implantation of CS devices by applying the presented hybrid approach [3,6,7,[22][23][24].…”

Outcomes of patients who undergo percutaneous coronary intervention with covered stents for coronary perforation: A systematic review and pooled analysis of data

“…The process of study selection is shown in Figure 1. From a total of 319 studies in our search, only 29 reports were included in the analysis 6,8–35 . The description of the included studies is shown in Table 1.…”

Clinical Outcomes of Self-Made Polyurethane-Covered Stent Implantation for the Treatment of Coronary Artery Perforations

“…This may reflect the combination of population with high burden of cardiovascular risk factors and complex lesions. Reported rates of in-hospital mortality for PTFE-CS in studies involving more patients ranged from 15% to 23% [ 20 , 26 ] and those of PU-CS were approximately 10% [ 19 , 21 ]. At 1-year follow-up, figures of all-cause mortality for PTFE-CS ranged from 26% to 41% [ 16 , 20 ], and those of PU-CS were approximately 26% [ 20 , 21 ].…”

“…According to Nagaraja and colleagues, the long-term mortality for patients receiving Graftmaster, PK Papyrus, and pericardial stents after CAP was 18.5%, 16.0%, and 26.1%, respectively [ 23 ]. Pavani et al conducted an investigation of 102 patients treated with CS (96 with PTFE-CS and 6 with pericardium-CS) after a dreadful grade III CAP and reported that the in-hospital MACE were mainly caused by high in-hospital mortality (14.7%) and acute ST (3.9%) whereas the long-term follow-up was acceptable despite a high ST (6.2%) [ 26 ]. And the cardiac tamponade was the critical sign of poor prognosis especially referring to the mortality rate at short-term follow-up [ 16 ].…”