Covered stent implantation through a single 8‐french guide catheter for the management of a distal coronary perforation

Sandoval, Yader; Lobo, Angie S.; Brilakis, Emmanouil S.

doi:10.1002/ccd.27020

Cited by 24 publications

(10 citation statements)

References 14 publications

(17 reference statements)

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“…Other methods including blood clot, fibrin glue, gelfoam, microspheres, silk suture, thrombin and skin embolization have also been reported in small studies . An alternative strategy, especially for small perforated vessels that cannot be engaged with a microcatheter is placement of a covered stent across the origin of the perforated vessel . Heparin reversal should be avoided until after all equipment is removed from the coronary artery to minimize the risk for coronary thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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Objectives We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. Background Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. Methods Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk‐adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One‐year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. Results Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22–13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in‐hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. Conclusions Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in‐hospital mortality, highlighting the importance of prevention.

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Section: Discussionmentioning

confidence: 99%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Nagaraja

Schwarz

Moss

et al. 2019

Cathet Cardio Intervent

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Objectives: This review aims to evaluate the adverse outcomes for patients after treatment with covered stents. Background: Coronary perforation is a potentially fatal complication of percutaneous coronary revascularization which may be treated using covered stents. Studies have evaluated long-term outcomes among patients who received these devices, but hitherto no literature review has taken place. Methods: We conducted a systematic review of adverse outcomes for patients after treatment with covered stents. Data from studies were pooled and outcomes were compared according to stent type. Results: A total of 29 studies were analyzed with data from 725 patients who received covered stents. The proportion of patients with chronic total occlusions, vein graft percutaneous coronary intervention (PCI), intracoronary imaging and rotational atherectomy were 16.9, 11.5, 9.2, and 6.6%, respectively. The stents used were primarily polytetrafluoroethylene (PTFE) (70%) and Papyrus (20.6%). Mortality, major adverse cardiovascular events, pericardiocentesis/tamponade and emergency surgery were 17.2, 35.3, 27.1, and 5.3%, respectively. Stratified analysis by use of PTFE, Papyrus and pericardial stents, suggested no difference in mortality (p = .323), or target lesion revascularization (p = .484). Stent thrombosis, pericardiocentesis/tamponade and emergency coronary artery bypass surgery (CABG) occurred more frequently in patients with PTFE stent use (p = .011, p = .005, p = .012, respectively). In-stent restenosis was more common with pericardial stent use (<.001, pooled analysis for first-and second-generation pericardial stents). Conclusions: Cases of coronary perforation which require implantation of a covered stent are associated with a high rate of adverse outcomes. The use of PTFE covered stents appears to be associated with more stent thrombosis, pericardiocentesis/ tamponade, and emergency CABG when compared to Papyrus or pericardial stents.

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“…In addition, these covered stents can also be used in the management of distal perforation by deployment across the side branch ostium. In distal vessel perforation, embolization or deployment of a covered stent across the ostium of the perforated branch to occlude it from the origin can be used[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Novel economic treatment for coronary wire perforation: A case report

Abdalwahab¹,

McQuillan²,

Farag³

et al. 2021

WJC

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BACKGROUND Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with embolization of coils, fat, thrombin, or collagen. We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation. we advocate this method as a simple method of managing distal vessel perforation. CASE SUMMARY A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex. At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation. A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences. CONCLUSION The use of a balloon remnant for embolization in coronary perforation presents a simple, efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome. Prevention remains the most important part with meticulous attention to the distal wire position, particularly with hydrophilic wires.

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Covered stent implantation through a single 8‐french guide catheter for the management of a distal coronary perforation

Cited by 24 publications

References 14 publications

Incidence, predictors, management and outcomes of coronary perforations

Incidence, predictors, management and outcomes of coronary perforations

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

Novel economic treatment for coronary wire perforation: A case report

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