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Yildiz BS, Gunduz R, Ozgur S, Cizgici AY, Ozdemir IH. Clinical Outcomes of Comparison Between Type III Coronary Artery Perforation (CAP) and non-CAP Acute Coronary Syndrome Patients During 3-Year Follow-up. Angiology 2023:33197231200029. [PMID: 37694576 DOI: 10.1177/00033197231200029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Coronary artery perforation (CAP) is a potentially fatal complication of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). This study aimed to investigate in-hospital, 1-year, and 3-year clinical outcomes of type III CAP during PCI in patients with ACS. The study retrospectively evaluated 118 patients with CAP and 43,226 case-control patients. Clinical, angiographic, and procedural characteristics, management, and outcomes were analyzed retrospectively at 1-year and 3-year follow-ups. The mean age of the patients was 66.5 ± 11.9 years (61.8% males). There was no significant difference in hospital mortality between the type III CAP and non-CAP groups. The all-cause mortality was 33.3% in the CAP group vs 1.8% in the non-CAP group at 1 year, and 28.3% in CAP group vs 6.9% in non-CAP group at 3 years (p = .001 for both comparisons). The procedural, clinical, and 1 and 3-year outcomes of type III CAP showed a relatively high risk of myocardial infarction, coronary artery bypass graft, cerebrovascular event, stent thrombosis, and major bleeding at the 1 and 3-year follow-ups. In addition, non-CAP ACS patients had better survival (log-rank: p < .001, 34.29 months 95% Confidence Interval [33.58-35.00]) than type III CAP ACS patients (29.53 months 95% Confidence Interval [27.28-31.78]) at the 3-year follow-up visit.
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Affiliation(s)
- Bekir S Yildiz
- Department of Cardiology, Celal Bayar University, Manisa, Turkey
| | - Ramazan Gunduz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Ahmet Y Cizgici
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training Research Hospital, Istanbul, Turkey
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2
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Rao SV, Kandzari DE. Lifting the Regulatory Blanket Off of Covered Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:37-38. [PMID: 37029040 DOI: 10.1016/j.carrev.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Sunil V Rao
- New York University Langone Health System, New York, NY, USA.
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3
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Voll F, Koch T, Tölg R, Lenz T, Schroeter M, Lenders G, Hokken R, Cassese S, Xhepa E, Schunkert H, Kastrati A, Kufner S. Clinical Safety and Efficacy of New-Generation Single-Layer Polytetrafluorethylene Covered Coronary Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:30-36. [PMID: 36822974 DOI: 10.1016/j.carrev.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Early-generation "sandwich-design" polytetrafluorethylene (PTFE) covered coronary stents (CS) are associated with a high frequency of adverse events. New-generation single layer PTFE-CS offers the potential to enhanced procedural efficacy and improves clinical safety. Data from a dedicated study, concerning outcomes after treatment with single-layer PTFE-CS in patients undergoing percutaneous coronary intervention are scant. METHODS This is a retrospective multicenter registry including 30 patients undergoing implantation of 39 single-layer PTFE-CS (BeGraft-coronary Stent Graft System, Bentley InnoMed GmbH, Hechingen, Germany) in native coronary arteries or saphenous bypass grafts, in 3 centers in Europe, between May 2013 and May 2019. Endpoints of interest were procedural success (placement of covered stent), binary-angiographic restenosis (BAR), percent diameter stenosis (% DS) and late-lumen loss at 6-8 months follow-up angiography, rates of target lesion revascularization (TLR), myocardial infarction (MI), stent thrombosis (ST) and mortality at 12 months. RESULTS 28 patients underwent implantation of 37 CS due to coronary artery perforation 2 patients due to coronary artery aneurysm. Technical success was achieved in all patients (100 %). More than one stent was implanted in 7 patients (25 %) all in the perforation group. Follow-up angiography was available in 23 patients (77 %) showing favorable results: BAR = 21.8 %, %DS = 30.3 ± 27.5; LLL = 0.16 ± 0.81 mm. At 12 months all patients were alive, rates of TLR were low (3 patients, 10.0 %), there was one case of late stent thrombosis (3.3 %) and one MI (3.3 %). CONCLUSIONS In this dedicated study, implantation of a new single layer PTFE-CS for the treatment of native coronary arteries or saphenous vein grafts after perforation or due to aneurysm showed high technical success rates and favorable angiographic and clinical efficacy. Clinical safety outcomes are encouraging, but larger prospective studies are needed to determine long-term safety of this device.
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Affiliation(s)
- Felix Voll
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ralph Tölg
- Herzzentrum der Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Tobias Lenz
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Mira Schroeter
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | | | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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4
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Danek BA, Kearney KE, Chung CJ, Steinberg Z, Lombardi WL, McCabe JM, Azzalini L. The contemporary role of protamine in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2023. [PMID: 37172213 DOI: 10.1002/ccd.30679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/14/2023]
Abstract
Access to the arterial circulation and full anticoagulation carries a risk of serious bleeding during and after percutaneous coronary intervention. Important sources of bleeding include the arterial access site and coronary artery perforation. Prompt and effective management of hemorrhagic complications is an essential interventional skill. Protamine sulfate is well-known as a heparin reversal agent. Despite this, there is heterogeneity in the use of protamine during interventional procedures. While protamine is generally well-tolerated, it is associated with a risk of hypersensitivity reaction, including anaphylaxis, among others. The purpose of this review is to summarize the existing evidence about and experience with the use of protamine sulfate in the setting of percutaneous coronary and structural interventional procedures.
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Affiliation(s)
- Barbara A Danek
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Christine J Chung
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Zachary Steinberg
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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5
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Strycek M, Jaworski L, Polasek R, Tomasov P. Coronary artery perforation successfully treated with a second drug-eluting stent. J Int Med Res 2023; 51:3000605231174998. [PMID: 37235714 DOI: 10.1177/03000605231174998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
A coronary artery perforation is a rare, but potentially lethal, complication of percutaneous coronary intervention. We present a case of massive main vessel coronary perforation of the right coronary artery in a patient with acute ST segment elevation myocardial infarction, which was successfully treated with a second drug-eluting stent. This uncommon therapeutic approach was used to preserve flow to the large side branch. Early recognition, rapid balloon re-inflation at the perforation site and a "ping-pong" guiding technique allowed us to prepare the optimal strategy and to treat the perforation without developing cardiac tamponade.
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Affiliation(s)
- Matej Strycek
- Cardiology Department, Liberec Regional Hospital, Czech Republic
| | - Lukas Jaworski
- Cardiology Department, Liberec Regional Hospital, Czech Republic
| | - Rostislav Polasek
- Cardiology Department, Liberec Regional Hospital, Czech Republic
- Faculty of Health Studies, The Technical University of Liberec, Czech Republic
| | - Pavol Tomasov
- Cardiology Department, Liberec Regional Hospital, Czech Republic
- Faculty of Health Studies, The Technical University of Liberec, Czech Republic
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6
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Kandzari DE, Sarao RC, Waksman R. Clinical experience of the PK Papyrus covered stent in patients with coronary artery perforations: Results from a multi-center humanitarian device exemption survey. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:97-101. [DOI: 10.1016/j.carrev.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
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7
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Abdelfattah OM, Saad AM, Kassis N, Shekhar S, Isogai T, Gad MM, Ahuja KR, Hariri E, Kaur M, Farwati M, Khatri J, Krishnaswamy A, Kapadia SR. Utilization and outcomes of transcatheter coil embolization for various coronary artery lesions: Single-center 12-year experience. Catheter Cardiovasc Interv 2021; 98:1317-1331. [PMID: 33205571 DOI: 10.1002/ccd.29381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Determining the outcomes of transcatheter coil embolization (TCE) for several coronary artery lesions. BACKGROUND TCE has been used as a treatment modality for various lesions in the coronary circulation. However, data on the efficacy and safety of TCE to treat coronary artery fistula (CAF), left internal mammary artery (LIMA) side-branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) are limited. METHODS We conducted a retrospective, descriptive analysis of all TCE devices in coronary lesions at our center from 2007 to 2019. Forty-one studied lesions included 25 CAF, 7 LIMA side-branch, 5 CAP, 2 CAA, and 2 CAPA. Short- and 1-year mortality and hospital readmission were reported, in addition to coil-related complications and procedural success. RESULTS The utilization rate of TCE in coronary artery lesions at our center was found to be 33.8 per 100,000 percutaneous coronary intervention procedures over 12 years. Successful angiographic closure was achieved in 37 out of 41 (87.8%) cases (88, 100, 60, 100, and 100% of CAF, LIMA side-branch, CAP, CAA, and CAPA, respectively). No adverse events were directly related to TCE among the LIMA, CAA, and CAPA cases, and only one patient with CAF required reintervention at 3 months due to coil migration. CONCLUSIONS Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with a 87.8% overall success rate. Further study on the use of vascular plug devices in cases such as CAF or LIMA side-branch would be beneficial to understand the treatment options better.
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Affiliation(s)
- Omar M Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Anas M Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed M Gad
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Keerat R Ahuja
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Medhat Farwati
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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8
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Clinical Outcomes following Large Vessel Coronary Artery Perforation Treated with Covered Stent Implantation: Comparison between Polytetrafluoroethylene- and Polyurethane-Covered Stents (CRACK-II Registry). J Clin Med 2021; 10:jcm10225441. [PMID: 34830722 PMCID: PMC8624773 DOI: 10.3390/jcm10225441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up.
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9
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Barioli A, Pellizzari N, Favero L, Cernetti C. Unconventional treatment of a giant coronary aneurysm presenting as ST-elevation myocardial infarction: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab385. [PMID: 34738061 PMCID: PMC8564704 DOI: 10.1093/ehjcr/ytab385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/13/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022]
Abstract
Background The optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous intervention or surgery is associated with low procedural success and poor outcomes. Case summary We report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with intravascular ultrasonography measured diameter of 9 mm and massive thrombus apposition. Discussion The technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.
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Affiliation(s)
- Alberto Barioli
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
- Corresponding author. Tel: +39 0423 731900, Fax: +39 0423 731901,
| | - Nicola Pellizzari
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
| | - Luca Favero
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
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10
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Ide S, Kiyosue H, Tokuyama K, Hori Y, Sagara Y, Kubo T. Direct Carotid Cavernous Fistulas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:583-592. [PMID: 37502141 PMCID: PMC10370662 DOI: 10.5797/jnet.ra.2020-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 07/29/2023]
Abstract
A direct carotid cavernous fistula (CCF) is an abnormal shunt between the internal carotid artery (ICA) and the cavernous sinus (CS). Traumatic CCF is the most common type, accounting for up to 75% of all CCFs. For the management of direct CCF, endovascular therapy has become the standard. For successful endovascular therapy, evaluation of the size and location of orifice of the CCF, venous drainage, and tolerance for ICA occlusion on cerebral angiography is necessary. Multi-planner reformatted images of 3D rotation angiography are useful to visualize the fistula and compartments of the CS precisely. Due to the limited commercial availability of detachable balloons, detachable coils have become a widely employed endovascular tool for the treatment of direct CCFs. The advantageous aspects of coil application are their easy retrievability and better control. In the case of large/multiple fistulas, adjunctive techniques, including balloon- and stent-assisted techniques, are often needed to occlude the CCF while preserving the ICA. To avoid cranial nerve palsy related to over-packing of the CS with detachable coils or a detachable balloon, selective embolization of the fistula portion is required. Use of liquid embolic materials and covered stents was recently reported as another adjunctive technique. In cases in which it is impossible to occlude the CCF while preserving the ICA, parent artery occlusion (PAO) is considered. The selection of additional/alternative techniques and devices depends on the anatomy and hemodynamics of each CCF, and the skill and experience of individual operators.
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Affiliation(s)
- Satomi Ide
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kohei Tokuyama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yuzo Hori
- Department of Radiology, Nagatomi Neurosurgical Hospital, Oita, Oita, Japan
| | - Yoshiko Sagara
- Department of Radiology, Tsurumi Hospital, Beppu, Oita, Japan
| | - Takeshi Kubo
- Department of Neurosurgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
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11
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Hernández-Enríquez M, Belle L, Madiot H, Pansieri M, Souteyrand G, de Poli F, Piot C, Boueri Z, Gerbaud E, Boiffard E, Benamer H, Lattuca B, Commeau P, Gervasoni R, Rangé G, Lhoest N, Marliere S, Abdellaoui M, Delarche N, Zemour G, Armengaud J, Carre M, Levesque S, Boudou N. Use and outcomes of the PK Papyrus covered stent in France: SOS PK Papyrus Registry. Catheter Cardiovasc Interv 2020; 98:874-881. [PMID: 33085150 DOI: 10.1002/ccd.29328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the rate of procedural success and long-term outcomes of the PK Papyrus (PKP) covered stent (CS). BACKGROUND CS are essential in the treatment of coronary artery perforation (CAP). They have also been used to treat coronary artery aneurysms. Limited evidence is available on clinical outcomes with the PKP. METHODS This was a multicenter, observational, retrospective, and prospective study. Consecutive patients undergoing intentional PKP implantation in 22 centers in France were included. The primary endpoint was the rate of procedural success. Secondary endpoints included rates of death, myocardial infarction (MI), target lesion revascularization (TLR), in-stent restenosis (ISR), and stent thrombosis (ST). RESULTS Data from 130 patients were analyzed (mean age 72.5 ± 10.5 years; 71% men). The main indication for PKP was CAP, in 84 patients (65%). Delivery success was achieved in 95% and procedural success in 91%. During the in-hospital stay, 15 patients died (12%) and 7 (5%) presented with ST. Data from 127 patients were available at 19.2 ± 12.8 month follow-up. Thirty-three patients died (26%), 15 (12%) had an MI and 21 (17%) presented with TLR. TLR was due to ISR in 12 patients (9%), 10 had definite ST (8%) and 1 patient for stent under-expansion. CONCLUSIONS The principal indication for PKP was CAP. PKP had high rates of delivery and procedural success. At long-term follow-up, there was a high rate of TLR, mainly due to ISR and ST. These results are consistent with previously reported data in these clinical settings.
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Affiliation(s)
- Marco Hernández-Enríquez
- Cardiology Department, Hospital Universitari General de Catalunya, Barcelona, Spain.,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Loic Belle
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Hende Madiot
- Cardiology Department, Hospital of Annecy, Annecy, France
| | | | - Geraud Souteyrand
- Cardiology Department, University Hospital of Clermont Ferrand, Clermont-Ferrand, France
| | - Fabiel de Poli
- Cardiology Department, Hospital of Haguenau, Haguenau, France
| | - Christophe Piot
- Cardiology Department, Private Hospital of Millenaire, Montpellier, France
| | - Ziad Boueri
- Cardiology Department, Hospital of Bastia, Bastia, France
| | - Edouard Gerbaud
- Cardiology Department, University Hospital of Bordeaux, Burdeaux, France
| | - Emmanuel Boiffard
- Cardiology Department, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Hakim Benamer
- Cardiology Department, ICPS Massy groupe Ramsay générale de santé, Aubervilliers, France
| | - Benoit Lattuca
- Cardiology Department, University Hospital of Nîmes, Nîmes, France
| | - Philippe Commeau
- Cardiology Department, Private Hospital of Clinique des Fleurs, Ollioule, France
| | - Richard Gervasoni
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Gregoire Rangé
- Cardiology Department, Hospital of Chartres, Chartres, France
| | - Nicolas Lhoest
- Cardiology Department, Private Hospital of L'Orangerie, Strasbourg, France
| | - Stéphanie Marliere
- Cardiology Department, University Hospital of Grenoble, Grenoble, France
| | - Mohamed Abdellaoui
- Cardiology Department, "Groupement Hospitalier Mutualiste" of Grenoble, Grenoble, France
| | | | - Gilles Zemour
- Cardiology Department, Hospital of Cannes, Cannes, France
| | | | - Max Carre
- Cardiology Department, Hospital of Auxerre, Auxerre, France
| | - Sebastien Levesque
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
| | - Nicolas Boudou
- Cardiology Department, Rangueil University Hospital, Toulouse, France
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12
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Mehta N, Satler L, Waksman R, Ben-Dor I. Percutaneous Management of a Saphenous Vein Graft Aneurysm With GraftMaster Covered Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:147-149. [PMID: 32978091 DOI: 10.1016/j.carrev.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Neil Mehta
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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13
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Barbero U, Cerrato E, Secco GG, Tedeschi D, Belliggiano D, Pavani M, Moncalvo C, Tomassini F, De Benedictis M, Doronzo B, Varbella F. PK Papyrus coronary stent system: the ultrathin struts polyurethane-covered stent. Future Cardiol 2020; 16:405-411. [DOI: 10.2217/fca-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the emergency setting of a coronary vessel perforation, the knowledge of materials needed to fix it and the intrinsic quality of the device used is mandatory for the interventional cardiologist. The PK Papyrus covered stent (Biotronik AG) is an ultrathin strut (60 μm) balloon-expandable stent covered on the abluminal surface with an electrospun polyurethane matrix. It is intended to facilitate device delivery and effectively treat coronary artery perforations. In published studies, rates of successful device delivery and perforation sealing were above 90%, respectively, and most events were usually resolved with a single stent. In this review we focused on the main technical characteristics as well on the published evidence that compare its performance with other coronary covered stent.
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Affiliation(s)
- Umberto Barbero
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli & San Luigi Gonzaga, Orbassano, Turin, Italy
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Delio Tedeschi
- Interventional Cardiology, Istituto Clinico S.Anna Gruppo Ospedaliero San Donato, Brescia, Italy
| | - Davide Belliggiano
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Marco Pavani
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Cinzia Moncalvo
- Cardiology Department, Santissima Annunziata Hospital, Savigliano, Italy
| | - Francesco Tomassini
- Interventional Cardiology, Infermi Hospital, Rivoli & San Luigi Gonzaga, Orbassano, Turin, Italy
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14
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Rezvova MA, Ovcharenko EA, Klyshnikov KY, Kudryavtseva YA. Promising polymeric compounds for coronary stent graft membrane. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The literature review discusses the studies on developing the polymer membrane of a coronary stent graft. The new generation of coronary stent grafts is designed to increase the hemocompatibility and ensure its delivery to poorly accessible artery regions. Based on the clinical use results, three groups of promising polymers were identified: biostable polyurethanes, polyvinyl alcohol-based cryogels, bioresorbable compositions based on polylactide-caprolactone and lactic acid-glycolic acid copolymer. However, the possibility of their clinical application requires further experimental studying.
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Affiliation(s)
- M. A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases
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15
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Taavitsainen J, Tarvainen S, Kuivanen A, Mangiardi EK, Guelcher M, Martin J, Mathur A, Hytönen JP, Ylä-Herttuala S. Evaluation of Biodegradable Stent Graft Coatings in Pig and Rabbit Models. J Vasc Res 2020; 57:65-75. [PMID: 32036370 DOI: 10.1159/000505454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
AIMS Percutaneous coronary intervention is routinely performed to treat occlusive coronary artery disease. Coronary perforation is a potential complication and can be treated with a stent graft. Current stent grafts are associated with high restenosis rates. We tested the safety and feasibility of biodegradable stent grafts in pig and rabbit models. METHODS AND RESULTS Stent grafts were examined in pig coronaries with repeated OCT imaging for 42 days. Novel biodegradable coatings were applied on a bare metal stent by either an electrospinning (ES) or dip coating (DC) method. A completely biodegradable system was made by ES coating a magnesium-based stent. A commercially available stent graft served as a control. ES devices showed less restenosis (44.3 ± 8.8 vs. 59.1 ± 11.1% in controls, p < 0.05) and smaller reduction in minimum lumen area (44.3 ± 13.4 vs. 64.4 ± 13.6% in controls, p < 0.05) at day 42. DC devices occluded during follow-up. ES devices showed recanalization through the graft wall at day 42. Feasibility of the ES and DC devices was evaluated in pig coronary aneurysms and rabbit aortic perforation models and sealed aneurysms and perforations without complications. CONCLUSIONS Recanalization of the graft wall improves biocompatibility. Biodegradable stent grafts may present an alternative to permanent implants by showing reduced restenosis at day 42.
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Affiliation(s)
- Jouni Taavitsainen
- A.I. Virtanen Institute for Molecular Sciences, Department of Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | - Santeri Tarvainen
- A.I. Virtanen Institute for Molecular Sciences, Department of Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecular Sciences, Department of Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | - John Martin
- University College London, London, United Kingdom
| | | | - Jarkko P Hytönen
- A.I. Virtanen Institute for Molecular Sciences, Department of Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, Department of Molecular Medicine, University of Eastern Finland, Kuopio, Finland,
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16
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Mangels D, Penny W, Reeves R. Left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting. Catheter Cardiovasc Interv 2019; 97:97-104. [DOI: 10.1002/ccd.28630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/16/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel Mangels
- Department of Cardiovascular Medicine University of California San Diego California
| | - William Penny
- Division of Cardiovascular Medicine, VA Medical Center University of California San Diego California
| | - Ryan Reeves
- Department of Cardiovascular Medicine University of California San Diego California
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17
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Patel NJ, Agasthi P, Mhatre AU, Heuser RR. Out of the Mind of Edward B. Diethrich: The Development of the Polytetrafluoroethylene-Covered Coronary Stent. J Endovasc Ther 2019; 27:157-159. [PMID: 31735115 DOI: 10.1177/1526602819887953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Ajay U Mhatre
- University of Arizona College of Medicine, Phoenix, AZ, USA
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18
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Nawale JM, Chaurasia AS, Borikar NA, Nalawade DD, Shah MM, Shinde PS. Single Center 7 Year Experience of Coronary Artery Perforation: Angiographic and Procedural Characteristics, Management and Outcome. Heart Views 2019; 20:93-100. [PMID: 31620254 PMCID: PMC6791097 DOI: 10.4103/heartviews.heartviews_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Context: Coronary artery perforation is a rare but potentially catastrophic complication of percutaneous coronary intervention (PCI). It is infrequent complication of PCI. Aims: The objective of the study is to report the 7-year experience of coronary artery perforation with respect to incidence, clinical and angiographic characteristics, management and outcomes. Settings and Design: The study involved retrospective analysis of single centre 7 years of percutaneous coronary intervention data. Patients who had complication of coronary artery perforation during PCI were identified and included in the study. Subjects and Methods: Retrospective analysis of clinical, angiographic and procedural characteristics as well as management and outcome of coronary artery perforation was done. Statistical Analysis Used: The whole data were tabulated, variables were presented as mean and percentages and comparison was done within them. Results: A total of 37 cases of coronary artery perforation were identified from 4532 PCI performed. Most of the coronary artery perforation belonged to Ellis Type II and Type III (both n = 15) followed by Type III CS and Type I. Lesions belonged to AHC/AHA Type C in 31 cases. Most frequent mechanism of coronary artery perforation was related to the use of guidewire and balloon (both n = 17). The total of 8 cases presented with cardiac tamponade requiring pericardiocentesis. Eleven cases required emergency covered stent implantation. In two cases microcoil was used while one case required polyvinyl alcohol particles to seal the perforation site. There was no in-hospital mortality while 30-day mortality occurred in one patient. One case was referred for emergency surgery. Conclusions: Coronary artery perforation is rare but potentially fatal complication of percutaneous coronary intervention. Complication of coronary artery perforation can be managed effectively in the catheterization laboratory without the need of emergency of bailout surgery and in-hospital outcomes remain good in the majority of cases.
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Affiliation(s)
- Jaywant M Nawale
- Department of Cardiology, TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Ajay S Chaurasia
- Department of Cardiology, TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Nikhil Anand Borikar
- Department of Cardiology, TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | | | - Meghav M Shah
- Department of Cardiology, TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Prashant S Shinde
- Department of Cardiology, TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
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19
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Garatti A, Daprati A, Saitto G, deVincentiis C, Menicanti L. Surgical management of multiple giant coronary artery aneurysms determining myocardial ischemia. J Card Surg 2019; 35:211-213. [DOI: 10.1111/jocs.14276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Garatti
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Andrea Daprati
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Guglielmo Saitto
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Carlo deVincentiis
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Lorenzo Menicanti
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
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20
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Seth A, Singh VP. Polytetrafluoroethylene covered stents during PCI: Wanting more from our “savior”. Catheter Cardiovasc Interv 2019; 94:562-563. [DOI: 10.1002/ccd.28517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Ashok Seth
- Fortis Escorts Heart Institute New Delhi India
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21
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Parikh P, Banerjee K, Sammour Y, Ali AF, Sankaramangalam K, Nair R, Ellis S, Raymond R, Tuzcu EM, Kapadia S. Utilization and outcomes of polytetrafluoroethylene covered stents in patients with coronary artery perforation and coronary artery aneurysm: Single center 15-year experience. Catheter Cardiovasc Interv 2019; 94:555-561. [PMID: 31429192 DOI: 10.1002/ccd.28448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/19/2019] [Accepted: 08/01/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Determine the outcomes of polytetrafluoroethylene (PTFE) covered stents for coronary artery perforation (CAP) and coronary artery aneurysm (CAA). BACKGROUND PTFE covered stents have been used for treatment of potentially life-threatening CAP and CAA. The short and long-term outcomes of the PTFE covered stent for CAP and CAA have not been well studied. METHODS We performed a retrospective study of PTFE covered stents that were placed in the patients from 2003 to 2017. Short term outcomes included in-hospital mortality, pericardial effusion, cardiac tamponade, and length of stay. Long-term outcomes included target lesion revascularization (TLR), in-stent restenosis (ISR), and long-term mortality. RESULTS Fifty-three PTFE covered stents were placed in 32 patients of which there were 24 patients with a CAP with a mean age of 75 ± 8 years. Two patients died in-hospital, with no additional deaths at 30 days. The rate of ISR was 25%, with estimated rates of TLR of 2.6% (3 years) and 17.8% (5 years). The median survival was 55.6 months, with survival at 10 years estimated to be 30.9%. Eight patients received a PTFE covered stent for CAA with a mean age of 59 ± 15 years with no in-hospital or 30-day mortality. Median follow-up of 49 months showed no evidence of TLR. The all-cause mortality was 12% at 1 year and 38% at 3 years. CONCLUSIONS PTFE covered stents is an effective option in patients with CAP and CAA. The long-term outcomes may be related to the pathology of the disease rather than the stent itself.
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Affiliation(s)
- Parth Parikh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ambreen F Ali
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kesavan Sankaramangalam
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Núñez-Gil IJ, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, de la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez-Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Bagur R, Ugo F, Medda M, Louka BF, Kala P, Escaned J, Bautista D, Feltes G, Salinas P, Alkhouli M, Macaya C, Fernández-Ortiz A. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR). Int J Cardiol 2019; 299:49-55. [PMID: 31378382 DOI: 10.1016/j.ijcard.2019.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Mario Bollati
- Interventional Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Belén Terol
- Cardiology Department, Hospital Severo Ochoa, Leganés, Spain
| | | | | | - Pedro A Villablanca
- Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; University of Oviedo, Oviedo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Benjamín Camacho
- Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Marco Pavani
- Cardiology, Città della Salute e della Scienza, Molinnette II, Torino, Italy
| | - Juan Albistur
- Cardiology, Hospital de Clínicas Dr, Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Emodinamica, Azienda Ospedaliera Universitaria Policlinico "P,Giaccone" Palermo, Italy
| | - Massimo Mancone
- Is Sapienza University of Rome, Policlinico Umberto I. Department of Cardiovascular, Respiratory, Neurological, Anaesthesiology and Geriatric Sciences
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Alfonso Ielasi
- Cardiology Division, ASST Bergamo Est, Bolognini Hospital Seriate, Italy
| | - Íñigo Lozano
- Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | - Pierluigi Omedè
- Cardiology, Città della Salute e della Scienza, Molinnette I, Torino, Italy
| | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fabrizio Ugo
- Interventional Cardiology, H San Giovanni Bosco, Turin, Italy
| | - Massimo Medda
- Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, USA
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Bautista
- Cardiology, Instituto dominicano de Cardiología, Santo Domingo, Dominican Republic
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Mohamad Alkhouli
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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23
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Awuor SO, Ettinger SE, Capecci LM, Pae WE. Graftmaster savior: Injury to a patent LIMA during pericardiectomy, when a covered stent came to the rescue. Catheter Cardiovasc Interv 2019; 93:E326-E330. [PMID: 30690858 DOI: 10.1002/ccd.28100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/02/2019] [Indexed: 11/07/2022]
Abstract
A 71-year-old male with multivessel coronary artery disease who underwent bypass with saphenous vein grafts to a Marginal branch and distal RCA and LIMA to LAD in 1988, DM II, atrial fibrillation on Coumadin, TIA, obstructive sleep apnea and pulmonary hypertension was referred to our institution after extensive dyspnea evaluation with a diagnosis of constrictive pericarditis for pericardiectomy. He had normal left ventricular function, moderate mitral and tricuspid regurgitation. Coronary angiography revealed ostial LAD CTO, patent LIMA to mid LAD, second Marginal branch CTO with left-to-left collaterals and mid RCA CTO with left-to-right collaterals. Vein grafts to the Marginal branch and distal RCA were occluded. The pericardium was heavily calcified on CT of the chest. The LIMA was inadvertently injured leading to acute STEMI and ventricular fibrillation arrest treated with defibrillation once. Surgical repair was unsuccessful. A Graftmaster covered stent was successful deployed with restoration of TIMI III flow to the LAD territory. Pericardiectomy was completed via both the median resternotomy and left thoracotomy. Triple therapy with Aspirin, Clopidogrel, and Coumadin was initiated and maintained for 3 months without hemorrhagic or thrombotic complications. He has continued to do well in follow-up on Clopidogrel and Coumadin.
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Affiliation(s)
- Stephen O Awuor
- Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Cardiology, Hershey, Pennsylvania
| | - Steven E Ettinger
- Interventional Cardiology, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Cardiology, Hershey, Pennsylvania
| | - Louis M Capecci
- Cardiothoracic Surgery, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Cardiothoracic Surgery, Hershey, Pennsylvania
| | - Walter E Pae
- Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Cardiothoracic Surgery, Hershey, Pennsylvania
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24
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Kandzari DE, Birkemeyer R. PK Papyrus covered stent: Device description and early experience for the treatment of coronary artery perforations. Catheter Cardiovasc Interv 2019; 94:564-568. [PMID: 31033148 DOI: 10.1002/ccd.28306] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronary artery perforation during percutaneous revascularization is associated with considerable morbidity and mortality. The PK Papyrus covered stent provides a physical barrier to seal perforated arteries and prevent associated complications including death. METHODS In a survey of patients treated for coronary artery perforation with the PK Papyrus stent in 16 countries, procedural and in-hospital outcomes were ascertained. Procedural variables included device delivery, sealing of the perforation, and complications related to the covered stent. RESULTS Among 80 patients with coronary perforation, Ellis classification was characterized as grade III or III-cavity spilling in 50.0% and 17.5% of events, respectively. The mean (±SD) number of stents attempted for use per patient was 1.25 ± 0.61. The PK Papyrus stent was successfully delivered to the site of perforation in 76 patients (95.0%), and successful sealing was reported in 73 patients (91.3%). Pericardiocentesis was performed in seven patients (8.8%), and in-hospital death occurred in eight patients (10.0%). Among patient deaths, Ellis grade III perforations were reported in all instances (data not reported in one patient), and two cases were associated with unsuccessful sealing of the perforation site. CONCLUSIONS The PK Papyrus covered stent is designed to overcome limitations of existing therapies and to facilitate device delivery and effectively treat coronary artery perforations. Initial experience demonstrates favorably high rates of successful delivery to and sealing of the perforation site. Despite treatment, in-hospital mortality remains high for patients experiencing Ellis grade III coronary perforations.
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25
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Ingrassia J, Youn YJ, Lee J, Azrin M, Khalid S. Novel approach to coronary artery perforation repair. Catheter Cardiovasc Interv 2019; 93:E98-E100. [PMID: 30196541 DOI: 10.1002/ccd.27849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/22/2018] [Accepted: 07/28/2018] [Indexed: 11/07/2022]
Abstract
Coronary artery perforation (CAP) during percutaneous coronary intervention is a rare but serious complication. Treatment options of CAP include prolonged balloon inflation, covered stent, and coil embolization. Although most cases of CAP can be treated with prolonged balloon inflation, some cases, especially Ellis grade III CAP require covered stents or coiling. Covered stents may require a large bore guide catheter and have a high rate of restenosis, which can be a limiting factor in patients with severe peripheral arterial disease. Coil embolization is generally used in distal CAP because coiling in the proximal vessels results in a large territory of infarction. We present a case of an Ellis grade III CAP during rotational atherectomy successfully treated with a novel coiling technique whereby the thrombogenic coil extends through the perforation outside of the vessel, and the intraarterial portion of the coil is excluded from the lumen by drug-eluting stent placement over the proximal portion of the coil.
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Affiliation(s)
- Joseph Ingrassia
- Division of Cardiovascular Medicine, Calhoun Cardiovascular Center, University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Gangwon, South Korea
| | - Juyong Lee
- Division of Cardiovascular Medicine, Calhoun Cardiovascular Center, University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael Azrin
- Division of Cardiovascular Medicine, Calhoun Cardiovascular Center, University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Salman Khalid
- Division of Cardiovascular Medicine, Calhoun Cardiovascular Center, University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut
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Kufner S, Schacher N, Ferenc M, Schlundt C, Hoppmann P, Abdel-Wahab M, Mayer K, Fusaro M, Byrne RA, Kastrati A. Outcome after new generation single-layer polytetrafluoroethylene-covered stent implantation for the treatment of coronary artery perforation. Catheter Cardiovasc Interv 2018; 93:912-920. [PMID: 30467994 DOI: 10.1002/ccd.27979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/30/2018] [Accepted: 10/23/2018] [Indexed: 11/06/2022]
Abstract
AIMS Coronary artery perforation (CAP) is a rare but severe complication during percutaneous coronary intervention (PCI). Implantation of covered stents (CS) represents a potentially life-saving treatment. Concerns exist regarding limited efficacy and high stent thrombosis (ST) rates related to early generation CS. The aim of this study was to evaluate angiographic and clinical outcomes of patients with CAP treated with a new generation single-layer polytetrafluoroethylene (PTFE)-CS. METHODS Between May 2013 and November 2017, we identified a total of 61 patients who underwent implantation of 71 single layer PTFE-CS after CAP. We analyzed angiographic results at follow up (including binary angiographic restenosis [BAR] and late-lumen-loss [LLL]) and clinical outcomes in hospital and at follow up, including target lesion revascularization (TLR), cardiovascular-, and all-cause mortality, myocardial infarction (MI) and stent thrombosis (ST). RESULTS Procedural success was achieved in all but two patients (96.7%). Procedure related MI, occurred in 19 cases (31.1%), in hospital death occurred in five cases (8.2%). At follow-up, TLR occurred in 11 cases (18.0%), two patients (3.3%) died from non-cardiovascular cause, there was no case of MI or ST. CONCLUSIONS In this retrospective analysis, implantation of a new generation PTFE-CS, for the treatment of CAP showed high technical success rates. Although, periprocedural MI-and in-hospital-death rates remain not inconsiderable, new generation PTFE-CS showed favorable angiographic and clinical efficacy and high safety profile, especially with regard to thrombotic events.
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Affiliation(s)
- Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nora Schacher
- Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany
| | - Miroslaw Ferenc
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Schlundt
- Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany
| | - Petra Hoppmann
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Universitätsherzzentrum Bad Krotzingen, Kardiologie 1, Bad Krotzingen, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Kahraman S, Agac MT, Demirci G, Gurbak I, Panc C, Yildiz M, Erturk M. Successful percutaneous treatment of coronary steal syndrome with the amplatzer vascular plug 4 and coil embolization. Intractable Rare Dis Res 2018; 7:287-290. [PMID: 30560024 PMCID: PMC6290846 DOI: 10.5582/irdr.2018.01083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The left internal mammary artery (LIMA) is widely used in coronary artery bypass grafting surgery due to its long term perfect patency rates. However, coronary steal syndrome can occur because of unligated LIMA side branches and it causes blood flow from coronary artery to LIMA. Even though the optimal therapy of coronary steal syndrome is still controversial, some percutaneous and surgical treatment modalities can be used in the treatment of steal phenomenon for relieving angina and resolving ischemia. It was demonstrated that percutaneous treatments such as the use of gelatin sponge particles or drug-eluting stents with covered stent, and coil and vascular plug embolization were used to treat this phenomenon successfully. Several studies revealed that these percutaneous treatments can reduce the ischemic area and results in prevention of blood flow from coronary artery to LIMA side branches. Supporting these findings, we herein present a 48-year-old male patient with objective ischemia with coronary steal syndrome treated successfully with the Amplatzer vascular plug (AVP) 4 and coil embolization in the same procedure. To the best of our knowledge, the combined therapy has not been described in the literature yet. Supporting the literature findings, successful treatment of LIMA side branches in our case with two different percutaneous modalities results in improvement of coronary flow and a reduced ischemic area and angina.
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Affiliation(s)
- Serkan Kahraman
- Department of Cardiology, University of Health Science, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
- Address correspondence to:Dr. Serkan Kahraman, Department of Cardiology, University of Health Science, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, TURKEY. İstasyon Mah. Turgut Özal Bulvarı No:11 Küçükçekmece/ISTANBUL E-mail:
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Rosseel L, Scott B, Prihadi E, Azzano A, Degrauwe S, Verheye S, Convens C, Vermeersch P. Is a covered stent justifiable in the treatment of coronary artery perforation? An observational analysis of long-term results of two different covered stent types. Catheter Cardiovasc Interv 2018; 93:419-425. [PMID: 30280487 DOI: 10.1002/ccd.27892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/03/2018] [Accepted: 08/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In this retrospective observational study, we investigate outcome of patients treated with or without covered stent (CS) implantation in the management of coronary artery perforation (CAP) during coronary intervention. BACKGROUND CSs have shown to be effective devices to achieve acute hemostasis in large CAP. However, doubts have been raised regarding their long-term outcome. METHODS Data of 19 061 PCI procedures during a 10-year period were reviewed. Fifty-five cases of large CAP were withheld (Ellis type 2, 3 or cavity spilling). All medical and procedural records of these cases were retrospectively reviewed. RESULTS Twenty-four (43.6%) patients were treated with CS implantation (15 polytetrafluoroethylene and 9 pericardium CSs). Twenty-six (47.3%) patients were managed without CS implantation, of whom five had unsuccessful delivery of a CS (stent delivery failure 17.2%). Although significantly more Ellis type-3 perforations were present in the CS group compared to the Non-CS group (75.0% vs 45.2%; P = 0.03), in-hospital mortality was not significantly different (8.3% vs 6.4%; [P = 0.79]). We observed a high rate of CS restenosis (29.2%) but a lower rate of CS thrombosis (4.2%). Despite these observations, 5-year MACE and all-cause mortality were not significantly different between CS and Non-CS group (respectively, 58.8% vs 50.0% (P = 0.26) and 26.7% vs 13.3% (P = 0.36)). CONCLUSION Although deliverability of CSs was not flawless and a high rate of CS restenosis appeared, short- and long-term outcome were comparable between patients treated with or without CS. Therefore, CSs are justifiable in the treatment of CAP.
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Pavani M, Cerrato E, Latib A, Ryan N, Calcagno S, Rolfo C, Ugo F, Ielasi A, Escaned J, Tespili M, Conrotto F, Mancone M, Colombo A, Varbella F. Acute and long-term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3-CAP registry. Catheter Cardiovasc Interv 2018; 92:1247-1255. [PMID: 30244520 DOI: 10.1002/ccd.27789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/17/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022]
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 long-term follow-up (mean 42 ± 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.
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Affiliation(s)
- Marco Pavani
- Division of Cardiology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Interventional Unit, Infermi Hospital, Rivoli and AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Azeem Latib
- Division of Cardiology, EMO GVM Columbus/San Raffaele, Milan, Italy
| | - Nicola Ryan
- Division of Cardiology, Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Simone Calcagno
- Department of Cardiovascular, Respiratory, Geriatric, Anesthesiology and Nephrology Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Cristina Rolfo
- Division of Cardiology, Interventional Unit, Infermi Hospital, Rivoli and AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Fabrizio Ugo
- Division of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Alfonso Ielasi
- Division of Cardiology, Bolognini Hospital Seriate, Bergamo, Italy
| | - Javier Escaned
- Division of Cardiology, Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Maurizio Tespili
- Division of Cardiology, Bolognini Hospital Seriate, Bergamo, Italy
| | - Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Geriatric, Anesthesiology and Nephrology Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Colombo
- Division of Cardiology, EMO GVM Columbus/San Raffaele, Milan, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit, Infermi Hospital, Rivoli and AOU San Luigi Gonzaga, Orbassano, Turin, Italy
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Hernández-Enríquez M, Lairez O, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, Elbaz M, Carrié D, Boudou N. Outcomes after use of covered stents to treat coronary artery perforations. Comparison of old and new-generation covered stents. J Interv Cardiol 2018; 31:617-623. [DOI: 10.1111/joic.12525] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Marco Hernández-Enríquez
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Olivier Lairez
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | | | | | - Frédéric Bouisset
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Jérôme Roncalli
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Meyer Elbaz
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Didier Carrié
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Nicolas Boudou
- Department of Cardiology; Rangueil University Hospital; Toulouse France
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Nakayama Y, Nishi S, Ishibashi-Ueda H, Okamoto Y, Nemoto Y. Development of Microporous Covered Stents: Geometrical Design of the Luminal Surface. Int J Artif Organs 2018; 28:600-8. [PMID: 16015570 DOI: 10.1177/039139880502800609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To reduce in-stent restenosis rates we have developed newly designed covered stents, in which a stent strut is buried into a microporous elastomeric cover film to provide a physical barrier against tissue ingrowth and a pharmacological reservoir for drug-eluting. The covered stents were prepared by dip-coating balloon expandable stents mounted on a stainless steel rod in a segmented polyurethane (SPU) solution, and were subsequently subjected to laser-processed microporing (pore diameter, 100 μm; interpore distance, 200 μm). The covered stents, which possessed flat luminal surfaces and micropores that were homogeneously arranged on the whole surface of the covering film, were deployed into the bilateral common carotid arteries of normal New Zealand white rabbits. Angiography after one month of implantation showed all stents were patent with little thrombus formation. The mean thickness of the formed neointimal layers was 292 ± 177 μm (n=8), which was close to the size in non-covered bare stent (231 ± 58 μm, n=7), but markedly decreased (about 2/3) from that in the previously developed wrapping-type covered stents (415 ± 173 μm, P<0.01, n=8).
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Affiliation(s)
- Y Nakayama
- Department of Bioengineering, National Cardiovascular Center Research Institute, Suita, Osaka, Japan.
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Hada Y, Fujii H, Shimizu M, Yamawake N, Nishizaki M. Effectiveness of Bare Metal Stent Implantation for the Treatment of Coronary Artery Aneurysm: A Multimodality Imaging Evaluation. Intern Med 2017; 56:3305-3309. [PMID: 29021434 PMCID: PMC5790718 DOI: 10.2169/internalmedicine.8532-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
Coronary artery aneurysm (CAA) after sirolimus-eluting stent (SES) implantation is one of the most troublesome problems associated with first-generation drug-eluting stents. However, the natural course and standard therapy of CAA has been unknown. A 49-year-old man underwent SES implantation for the left anterior descending artery. Follow-up coronary angiography (CAG) revealed CAA in the SES. We performed bare metal stent (BMS) implantation for treatment of CAA. Ten months after the BMS implantation, the size of the CAA had diminished, and a very thin layer of endothelium on the BMS was observed by optical coherence tomography. CAG assessment revealed that the blood stream of the CAA had been obstructed. We herein report a case of CAA after SES implantation with eight years of follow-up and the findings of a multimodality imaging evaluation.
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Affiliation(s)
- Yasuaki Hada
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
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Nasrin S, Cader FA, Haq MM, Karim MR. Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report. BMC Res Notes 2017; 10:537. [PMID: 29084606 PMCID: PMC5663076 DOI: 10.1186/s13104-017-2867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background Right coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention. Case presentation A 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection. Conclusions The polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended. Electronic supplementary material The online version of this article (10.1186/s13104-017-2867-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahela Nasrin
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
| | - Fathima Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh. .,National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
| | - M Maksumul Haq
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
| | - Md Rezaul Karim
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
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Giant coronary aneurysm management with Viabahn covered stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:56-59. [DOI: 10.1016/j.carrev.2017.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022]
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Werner GS, Ahmed WH. Fenestration of a Papyrus PK covered stent to recover the occluded left main bifurcation after sealing a left main perforation during a CTO procedure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:41-44. [DOI: 10.1016/j.carrev.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/10/2023]
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Lee WC, Hsueh SK, Fang CY, Wu CJ, Hang CL, Fang HY. Clinical Outcomes Following Covered Stent for the Treatment of Coronary Artery Perforation. J Interv Cardiol 2016; 29:569-575. [PMID: 27781308 DOI: 10.1111/joic.12347] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate short- and long-term outcomes of polytetrafluoroethylene covered stent for patients with coronary artery perforation. METHODS During April 2004 and February 2016, a total 48 patients underwent implantation using polytetrafluoroethylene-covered JOSTENT GraftMaster stents (Abbott Vascular, Santa Clara, CA) in the native coronary arteries implantation for coronary artery perforation. Clinical outcomes such as target lesion revascularization (TLR), myocardial infarction (MI), definite or possible stent thrombosis, cardiovascular mortality, and all-cause mortality were analyzed. RESULTS The average age of study patients was 68.02 ± 13.49 years, and the majorities were men (76.6%). The most frequent devices cause of perforation were stents (37.5%). Eighteen patients (37.5%) experienced cardiac tamponade and 20 patients (41.7%) underwent emergent pericardiocentesis. Only 1 patient (2.1%) experienced emergent surgical repair after covered stent. At the 30-day follow-up, the rate of all-cause mortality was 16.7% and cardiovascular mortality was 13.0%. At the 1-year follow-up, the rate of MI was 6.1%, the rate of TLR was 21.9%, the rate of definite or possible stent thrombosis was 15.6%, the rate of cardiovascular mortality was 22.0%, and the rate of all-cause mortality was 26.2%. Between the patients with and without cardiac tamponade, patients with cardiac tamponade had higher cardiovascular mortality in 30-day and also higher all-cause mortality in 30-day and 1-year follow-up. CONCLUSION The covered stent could solve emergent condition for patients with coronary artery perforation with high TLR and stent thrombosis rate at long-term follow-up. The patients with cardiac tamponade had worse clinical outcomes in 30-day and 1-year follow-up.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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Warisawa T, Naganuma T, Nakamura S, Hartmann M, Stoel MG, Louwerenburg JHW, Basalus MWZ, von Birgelen C, Koo BK. How should I treat multiple coronary aneurysms with severe stenoses? EUROINTERVENTION 2016; 11:843-6. [PMID: 26603993 DOI: 10.4244/eijv11i7a171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Takayuki Warisawa
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
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Dash D. Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout. Indian Heart J 2016; 68:737-746. [PMID: 27773418 PMCID: PMC5079195 DOI: 10.1016/j.ihj.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury). Further, certain complications (such as donor vessel dissection or thrombosis) are unique to CTO-PCI. There are also complications related to specialized techniques, such as dissection/reentry and retrograde crossing techniques. A thorough understanding of the potential complications is critical to mitigate risk during these complex procedures.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India; Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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Wendl CM, Henkes H, Martinez Moreno R, Ganslandt O, Bäzner H, Aguilar Pérez M. Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants. Clin Neuroradiol 2016; 27:493-501. [PMID: 27129454 PMCID: PMC5719129 DOI: 10.1007/s00062-016-0511-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
Purpose Retrospective evaluation of our experience with the use of flow diverters (FD) for the endovascular treatment of direct carotid-cavernous sinus fistulae (diCCF). Methods Between 2011 and 2015, 14 consecutive patients with 14 diCCF were treated with FD alone or in combination with other implants in a single institution. Results A total of 21 sessions were performed in 14 patients. FD placement was technically successful in all cases without an adverse event. Patients were treated with FD alone (n = 5), FD and covered stents (n = 2), FD and coils (n = 7). A total of 59 FD (24 Pipeline Embolization Device, Medtronic; 35 p64 Flow Modulation Device, phenox), 291 coils, and 3 stent grafts were used. Three of 14 diCCF were completely occluded after the 1st session, a minor residual shunt was found in 7/14, and in the remaining 4/14 patients, the shunt volume was reduced significantly. The mean follow-up period encompassed 20 months. Additional treatment included transvenous coil occlusion (n = 3) and/or further FD deployment (n = 5). An asymptomatic internal carotid artery (ICA) occlusion was encountered in 2 patients, related to an interruption of antiaggregation. At the last follow-up, 10/14 patients were free from ocular symptoms (71 %), 2 had residual exophthalmos, and no patient had clinical deterioration. Conclusion The usage of FD for the treatment of diCCF is straightforward. Injury of the cranial nerves can be avoided. In most cases, ocular symptoms improve. Several FD layers and/or an adjunctive venous coil occlusion are required. Complete occlusion of a diCCF may take weeks or months and long-term antiaggregation is required. In the future, a flexible stent graft might be a better solution.
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Affiliation(s)
- C M Wendl
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany. .,Institut für Röntgendiagnostik, Zentrum für Neuroradiologie, Universitätsklinikum Regensburg, Regensburg, Germany.
| | - H Henkes
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.,Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| | - R Martinez Moreno
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - O Ganslandt
- Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - H Bäzner
- Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - M Aguilar Pérez
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
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40
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Monteleone PP, Yeh RW. Management of Complications. Interv Cardiol Clin 2016; 5:201-209. [PMID: 28582204 DOI: 10.1016/j.iccl.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention (PCI) has matured rapidly to tackle increasingly complex coronary disease. Operators must be aware of the incidence of the basic risks involved with coronary angiography and PCI to appropriately inform patients and obtain procedural consent. Even before a wire enters a coronary artery, specific risks, including vascular access complications, renal injury, allergic reaction, and radiation injury, are constantly present. With initiation of PCI, new risks to the coronary circulation arise. A fundamental knowledge of the presentation of these complications and expert ability to emergently manage them are of the utmost importance to the successful completion of PCI.
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Affiliation(s)
- Peter P Monteleone
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Robert W Yeh
- Division of Cardiology, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
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Kawamoto H, Tanaka K, Ruparelia N, Takagi K, Yabushita H, Watanabe Y, Mitomo S, Matsumoto T, Naganuma T, Fujino Y, Ishiguro H, Tahara S, Kurita N, Nakamura S, Hozawa K, Nakamura S. Short-Term and Long-Term Outcomes After Polytetrafluoroethylene-Covered Stent Implantation for the Treatment of Coronary Perforation. Am J Cardiol 2015; 116:1822-6. [PMID: 26602072 DOI: 10.1016/j.amjcard.2015.09.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
This study sought to evaluate the short-term and 3-year outcomes of polytetrafluoroethylene-covered stent (PCS) for patients with coronary perforation. Implantation of a PCS has improved the immediate clinical outcomes of patients with coronary perforation. However, there are few reports regarding long-term outcomes. We evaluated a total of 57 patients who were treated with PCS for coronary perforation from April 2004 to March 2015 at a single high-volume center in Japan. Landmark analysis was performed at 30 days to determine short-term and long-term outcomes. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, target vessel revascularization, and requirement for surgical repair. Of 285 patients who experienced coronary perforation, 57 patients (20%) were treated with PCS. The MACE rates were 28% at 30 days, 22% at 1 year, and 38% at 3 years. 30-day MACE was mainly driven by high rates of myocardial infarction (18%) and surgical repair (16%). The rates of target lesion revascularization were 8% and 12% at 1 and 3 years, respectively. Definite stent thrombosis was reported in 2 patients during the follow-up period. In conclusion, despite the relatively high incidence of MACE during early stage of follow-up, implantation of a PCS provides acceptable late clinical outcomes.
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Wu CJ, Lin WC, Hsu JS, Han IT, Hsieh TJ, Liu GC, Chiang IC. Follow-up for covered stent treatment of carotid blow-out syndrome in patients with head and neck cancer. Br J Radiol 2015; 89:20150136. [PMID: 26529227 DOI: 10.1259/bjr.20150136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Carotid blow-out syndrome (CBS) is a life-threatening complication of head and neck cancer (HNC). One of the various methods used for emergency management of CBS is covered stent placement (CSP). Our initial experience in CSP is evaluated and compared with reports in the literature. METHODS This study analysed 17 patients with HNC who had received CSP for CBS at Kaohsiung Medical University Chung-Ho Memorial Hospital from May 2005 to December 2013. The medical records and images for these patients were retrospectively reviewed to evaluate the causes of CBS, treatment success rates and complications. RESULTS The initial angiography success rate was 100%. Procedural or periprocedural complications were noted in two (12%) cases, both suffering from cerebral vascular accident (CVA). Short-term complications were noted in eight (47%) cases, including four rebleeding cases and four CVA cases. Medium- to long-term complications were noted in nine cases, which included two asymptomatic in-stent thrombosis cases, one symptomatic CVA case, two abscess formation cases and four rebleeding cases. Overall, eight (47%) cases of rebleeding occurred during follow-up. Three of the eight cases were fatal, accounting for 27% of the all-cause mortality. CONCLUSION Although CSP is considered effective for achieving haemostasis in patients with HNC with CBS, the medium- to long-term outcomes are unfavourable owing to high risks of rebleeding, CVA and other complications. Therefore, CSP should be considered a temporary life-saving technique rather than a definitive treatment. ADVANCES IN KNOWLEDGE Analysis of the relatively large series of patients with HNC in this study suggests that CSP is a useful temporary treatment for CBS.
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Affiliation(s)
- Chia-Jen Wu
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Chen Lin
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jui-Sheng Hsu
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,2 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ting Han
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsyh-Jyi Hsieh
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gin-Chung Liu
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chan Chiang
- 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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43
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In-stent restenosis in a polytetrafluoroethylene covered stent combined with drug eluting stents: potential pathogenesis revealed by optical coherence tomography. Int J Cardiol 2015; 198:42-4. [DOI: 10.1016/j.ijcard.2015.06.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/20/2015] [Indexed: 11/19/2022]
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44
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Piraino D, Dendramis G, Buccheri D, Paleologo C, Teresi G, Rotolo A, Andolina G, Assennato P. Coronary artery perforation: How to treat it? COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Chen S, Lotan C, Jaffe R, Rubinshtein R, Ben-Assa E, Roguin A, Varshitzsky B, Danenberg HD. Pericardial covered stent for coronary perforations. Catheter Cardiovasc Interv 2015; 86:400-4. [DOI: 10.1002/ccd.26011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 04/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Shmuel Chen
- Department of Cardiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Chaim Lotan
- Department of Cardiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Ronen Jaffe
- Department of Cardiology; Lady Davis Carmel Hospital; Haifa Israel
| | | | - Eyal Ben-Assa
- Department of Cardiology; Tel Aviv Medical Center; Tel Aviv Israel
| | - Ariel Roguin
- Department of Cardiology; Rambam Medical Center, Rappaport - Faculty of Medicine; Technion, Israel Institute of Technology; Israel
| | - Boris Varshitzsky
- Department of Cardiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Haim D. Danenberg
- Department of Cardiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
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46
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Kimura T, Itoh T, Sugawara S, Fusazaki T, Nakamura M, Morino Y. Serial endovascular assessment of polytetrafluoroethylene-covered stent: Capabilities and limitations of intravascular imaging modalities affected by a temporal factor. J Cardiol Cases 2014; 11:91-95. [PMID: 30546539 DOI: 10.1016/j.jccase.2014.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 10/07/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022] Open
Abstract
A 47-year-old male who previously underwent coronary bypass graft surgery was transferred to our hospital for treatment of bare metal in-stent restenosis (ISR) of severely calcified left main (LM) coronary lesion. During a repeat coronary intervention, LM coronary perforation occurred after rotational atherectomy followed by balloon dilatation. Hemostasis was successfully achieved by implantation of a single polytetrafluoroethylene (PTFE)-covered stent. Although intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were documented, any additional information was not obtained except stent expansion. Routine 6-month follow-up angiography revealed no findings of restenosis. Three representative imaging modalities, IVUS, OCT, and angioscopy were applied to visualize and differentiate any structures within the PTFE-covered stent. Intravascular findings included, (1) vascular structures outside the covered stent could be observed sufficiently by both IVUS and OCT at this time that could not be seen at all just after implantation, (2) neointimal hyperplasia distributed dominantly at both stent edges, and (3) in-stent micro thrombi still existed even 6 months after implantation. Intravascular findings of PTFE-covered stent may vary between the observational periods. Furthermore, vascular healing process of this special stent may be different from those of non-covered mesh stents. <Learning objective: Even with the use of IVUS and OCT, it may be difficult to evaluate apposition of PTFE-covered stent just after implantation. However, it could be visualized as being sufficiently similar to the other common stents at 6-month follow-up. Unique longitudinal NIH distribution (bilateral edge dominant) was evaluated, and existence of micro thrombi within PTFE-covered stent even at 6 months.>.
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Affiliation(s)
- Takumi Kimura
- Division of Cardiology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Tomonori Itoh
- Division of Cardiology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shoma Sugawara
- Division of Cardiology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Tetsuya Fusazaki
- Division of Cardiology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Motoyuki Nakamura
- Division of Cardio-angiology, Nephrology and Endocrinology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yoshihiro Morino
- Division of Cardiology, The Department of Internal Medicine, Iwate Medical University, Iwate, Japan
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Chin Yong A, Wei Chieh JT. Coronary Perforation Complicating Percutaneous Coronary Intervention - A Case Illustration and Review. ACTA ACUST UNITED AC 2014; 21:3. [PMID: 26316662 PMCID: PMC4544476 DOI: 10.7603/s40602-013-0002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI). Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.
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Affiliation(s)
- Ang Chin Yong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
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48
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Boganashanmugam V, Psaltis PJ, Antonis P. Intravascular ultrasound-guided management of large thrombus burden in an aneurysmal coronary artery in a young male. Catheter Cardiovasc Interv 2014; 88:E198-E202. [PMID: 24482079 DOI: 10.1002/ccd.25419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 11/11/2022]
Abstract
Management of acute thrombotic occlusion of coronary artery aneurysms is challenging with a lack of randomized trial evidence. We report an unusual case of a 30-year-old Indian Australian male who presented with an extensive anterior STEMI because of very large thrombus burden in a dilated proximal left anterior descending artery. A relatively conservative treatment approach comprising emergency aspiration thrombectomy and ongoing infusion of glycoprotein IIb/IIIa inhibitor, guided by surveillant inpatient angiography and intravascular ultrasound, helped achieve a satisfactory outcome in a complex setting in which percutaneous coronary angioplasty and stenting were not desirable. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Peter J Psaltis
- Monash Heart, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - Paul Antonis
- Monash Heart, Monash Medical Centre, Clayton, Victoria, 3168, Australia
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Staged hybrid treatment for contained rupture of a large right coronary artery aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:69-71. [PMID: 24406321 DOI: 10.1097/imi.0000000000000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a staged approach to the management of a rare acute condition--contained rupture of a large right coronary artery aneurysm. A covered stent was deployed percutaneously to isolate the aneurysm at presentation followed by planned coronary bypass grafting. Treatment interval was complicated by new-onset pulmonary tuberculosis and subacute thrombosis of the covered stent leading to nonfatal inferior myocardial infarction. Coronary surgery was performed after complete antitubercular treatment and resolution of the acute pericarditis/thrombosis as a consequence of the contained rupture. The advantages of this staged approach included the following: (a) The covered stent prevented both acute myocardial infarction and progressive pseudoaneurysm expansion in the acute phase. (b) Deferred surgery was rendered technically less hazardous while avoiding the undesirable option of having to exclude an extremely calcified dominant right coronary artery. The patient made an excellent postoperative recovery with complete resolution of her symptoms at 6 weeks' follow-up.
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50
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Khoshbin E, Sogliani F, Tang A. Staged Hybrid Treatment for Contained Rupture of a Large Right Coronary Artery Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Espeed Khoshbin
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital, Blackpool, UK
| | - Franco Sogliani
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital, Blackpool, UK
| | - Augustine Tang
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital, Blackpool, UK
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