Early clinical experience with the implantation of a novel synthetic coronary stent graft

Abstract

Coating stents with autologous venous grafts has been suggested to prevent problems associated with conventional stenting, but the need for surgical vessel harvest hampered broad application. A novel synthetic coronary stent graft (CSG) overcomes this limitation by a synthetic membrane, fixed between two thin metallic stents. We successfully implanted 21 CSGs in 18 patients for treatment of acute coronary rupture, thrombus‐containing lesions, and lesions with plaque rupture or adjacent pseudoaneurysm. Substantial residual angiographic diameter stenoses were seen in seven CSGs (25% ± 10% vs. 8% ± 6%; P < 0.01), which were implanted with relatively small balloon catheters (balloon‐to‐artery ratio 1.00 ± 0.09 vs. 1.24 ± 0.18; P = 0.01) and required postdilatation. Overall, the largest balloon catheter applied measured 4.0 ± 0.7 mm (balloon‐to‐artery ratio 1.21 ± 0.20) and the inflation pressure was 16 ± 3 atm. Final intravascular ultrasound imaging demonstrated adequate and symmetrical expansion of the CSG (≥85% ± 15% of the reference lumen). Elective implantation was associated with two small non–Q‐wave myocardial infarctions, resulting from unavoidable occlusions of side branches. Thus, implantation of CSG is feasible and safe. Adequate expansion can be achieved by the use of relatively large low‐compliant balloon catheters inflated with high pressure. Cathet. Cardiovasc. Intervent. 47:496–503, 1999. © 1999 Wiley‐Liss, Inc.

Covered stents: A review

“…Thus, covered stents, avoiding blood leakage between stent struts, may be an alternative to emergency surgery especially in the case of rapid deterioration and should be the preferred choice of therapy in the case of coronary perforation [8]. These positive findings have also been confirmed in other reports [9][10][11][12][13][14][15]. Therefore, compared to surgical interventions and hand-manufactured stent grafts, the implantation of synthetic stent grafts is less invasive, more efficient and timely, and appear to offer the best treatment option for acute perforations.…”

Left main coronary artery aneurysm: Sealing by stent graft and long-term follow-up

“…Another option is to use percutaneous technique to exclude the aneurysm. It is now rather common to use SG to seal off a coronary aneurysm [5,6]. The main concern of using SG is in-stent restenosis, especially at both ends of the SG, although the exact incidence is still not certain [7].…”

Use of Stent Grafts and Coils in Vessel Rupture and Perforation

“…Modern percutaneous options for the treatment of coronary perforation include prolonged inflation of a standard or perfusion balloon, use of stents, especially covered stents, 11,16–21 and coil embolization 22–26 for distal vessel perforation or rupture. Other techniques reported include the use of thrombin injection, 25,27 fibrin glue, 28 and gelfoam embolization 29 …”