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An W, Ye J, Han B, Wang X, Han C, Gao J, Liu Z. Efficacy and safety of self-made covered coronary stent in the treatment of coronary artery perforation. BMC Cardiovasc Disord 2023; 23:537. [PMID: 37923982 PMCID: PMC10625290 DOI: 10.1186/s12872-023-03575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE To observe the efficacy and safety of self-made covered coronary stent in the treatment of coronary artery perforation. METHODS Covered coronary stent was prepared by wrapping 3 M film on the surface of coronary stents. The beagle dogs were divided into control group and experimental group. A drug-eluting stent (DES) was implanted in the control group. The covered stent was applied to block the coronary branches of beagle dogs. The CaIMR value after stent placement was calculated by FlashAngio software. The effect of blocking the coronary branches on blood flow was observed by coronary angiography (CAG). The condition of the implanted stent was observed by optical coherence tomography (OCT), and the histopathologic examination of the coronary vessel implanted stent was performed by HE staining. RESULTS The best number of layers was 2. Compared with the control group, the CaIMR of the experimental group increased (p < 0.05). A lot of in-stent thrombosis were found in the experimental group and obvious blood flow obstruction during follow-up. HE staining showed that stents implanted in the two groups adhered well to the wall of the blood vessel, but in-stent thrombosis and intimal hyperplasia were founded in the experimental group, while the in-stent restenosis was not founded. CONCLUSION The self-made coronary covered stent can effectively block the leakage caused by coronary perforation, but the stent endothelialization is poor, which easily causes stent thrombosis and restenosis, so it is not recommended as a routine remedy.
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Affiliation(s)
- Wen An
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Jian Ye
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, People's Republic of China
| | - Bingyu Han
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Xu Wang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Chao Han
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China
| | - Junqing Gao
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China.
| | - Zongjun Liu
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People's Republic of China.
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2
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Ayoub M, Corpataux N, Tajti P, Behnes M, Schupp T, Forner J, Akin I, Westermann D, Rudolph V, Mashayekhi K. A Novel Strategy for Emergency Treatment of Coronary Perforations by Placing a Drug-Eluting Stent before Sealing off the Leakage with a Covered Stent to Improve Long-Term Outcomes in Patients with Coronary Artery Perforations. J Pers Med 2023; 13:1542. [PMID: 38003857 PMCID: PMC10672714 DOI: 10.3390/jpm13111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
We aimed to investigate the safety, feasibility, and long-term results of drug-eluting stent implantation before covered stents for treating coronary artery perforation (CAP). Between 2015 and 2020, 12,733 patients undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. The primary endpoint was 1-year target lesion revascularization (TLR), whereas secondary endpoints included the rate of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death at 1 year. A total of 159 patients with CAP were identified during the study period, of whom 47.2% (n = 75) were treated with a covered stent (CS group) because of complex and/or severe CAP and 84 (52.8%) without (non-CS group). In the majority of patients, emergency drug-eluting stent placement before covered stent implantation was feasible (n = 69, 82%). There were no significant differences among patients treated with or without a covered stent in terms of primary or secondary clinical endpoints: a similar rate of TLR (18.67% vs. 21.43%, p = 0.6646), MACCE (25.33% vs. 22.62%, p = 0.6887), and 1-year mortality (12.00% vs. 11.90%, p = 0.9853) were identified comparing cases with covered stent implantation and without. In conclusion, our study implicates that the use of covered stents for sealing coronary perforation might not impact the 1-year clinical outcome if used properly. Moreover, the emergent use of drug-eluting stents before covered stent implantation in CAP is a safe and effective method to avoid target lesion revascularization in patients treated with covered stents.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Division of Cardiology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Péter Tajti
- Division of Interventional Cardiology, Gottsegen Gyorgy National Cardiovascular Center, 1096 Budapest, Hungary
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Jan Forner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
- Faculty of Medicine Göttingen, University of Göttingen, 37077 Göttingen, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Dirk Westermann
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
- Clinic of Internal Medicine and Cardiology, Heart Center Lahr, 77933 Lahr, Germany
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3
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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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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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Matsuura H, Mukai Y, Honda Y, Nishino S, Kang H, Kadooka K, Ogata K, Kimura T, Koiwaya H, Nishihira K, Kuriyama N, Shibata Y. Intra- and Postprocedural Management of Coronary Artery Perforation During Percutaneous Coronary Intervention. Circ Rep 2022; 4:517-525. [DOI: 10.1253/circrep.cr-22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hirohide Matsuura
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Yasushi Mukai
- Department of Cardiology, Japanese Red Cross Fukuoka Hospital
| | - Yasuhiro Honda
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Honsa Kang
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kosuke Kadooka
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Toshiyuki Kimura
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Hiroshi Koiwaya
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
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6
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Di Mario C, Ciardetti N, Demola P. Second Generation: Better Also for Covered Stents? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:29-31. [PMID: 34420692 DOI: 10.1016/j.carrev.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy.
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
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7
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Clinical Outcomes of Self-Made Polyurethane-Covered Stent Implantation for the Treatment of Coronary Artery Perforations. J Interv Cardiol 2021; 2021:6661763. [PMID: 34104120 PMCID: PMC8143889 DOI: 10.1155/2021/6661763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The present study aimed to investigate the short- and long-term clinical outcomes of self-made polyurethane-covered stents (PU-CS) in patients for the management of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI). Background Coronary artery perforation is reckoned as a serious complication in PCI and associated with considerable morbidity and mortality. Covered stents have been used for treating the life-threatening CAP during PCI. But in some catheterization laboratories, no commercial CS is immediately available when there is an urgent need for CS to rescue the coronary rupture site. Methods We retrospectively identified 24 patients who underwent 31 self-made PU-CS implantations due to CAP in Zhongshan Hospital, Fudan University, from June 2015 to January 2020. Results The total procedural success rate of CS to seal the perforation was 79.2%. Nine patients (37.5%) developed cardiac tamponade, of which 8 patients (33.3%) underwent pericardiocentesis and 4 patients (16.7%) underwent cardiac surgeries. Except for 4 cardiac death cases (16.7%), none of myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) was reported during hospital stay. Data from 22 patients (91.7%) were available at 610.4 ± 420.9 days of follow-up. Major adverse cardiac events (MACE) occurred in 6 patients (27.3%), including 5 cases of cardiac death and one TLR case. Conclusions Self-made PU-CS demonstrates high rates of successful delivery and sealing of severe CAP during PCI. Although the in-hospital mortality remains high after PU-CS implantation, the long-term follow-up shows favorable clinical outcomes, indicating the feasibility of PU-CS in treating CAP.
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8
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Cerrato E, Pavani M, Barbero U, Colombo F, Mangieri A, Ryan N, Quadri G, Tomassini F, Presutti DG, Calcagno S, Franzè A, Bellini B, D'Ascenzo F, Ielasi A, De Benedictis M, Azzalini L, Mancone M, Escaned J, Montorfano M, Latib A, Varbella F. Incidence, Management, Immediate and Long-Term Outcome of Guidewire and Device Related Grade III Coronary Perforations (from G3CAP - Cardiogroup VI Registry). Am J Cardiol 2021; 143:37-45. [PMID: 33387472 DOI: 10.1016/j.amjcard.2020.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
Ellis grade III coronary artery perforations (G3-CAP) remain a life-threatening complication of percutaneous coronary intervention (PCI), with high morbidity and mortality and lack of consensus regarding optimal treatment strategies. We reviewed all PCIs performed in 10 European centers from 1993 to 2019 recording all G3-CAP along with management strategies, in-hospital and long-term outcome according to Device-related perforations (DP) and Guidewire-related perforations (WP). Among 106,592 PCI (including 7,773 chronic total occlusions), G3-CAP occurred in 311 patients (0.29%). DP occurred in 194 cases (62.4%), more commonly in proximal segments (73.2%) and frequently secondary to balloon dilatation (66.0%). WP arose in 117 patients (37.6%) with chronic total occlusions guidewires involved in 61.3% of cases. Overall sealing success rate was 90.7% and usually required multiple maneuvers (80.4%). The most commonly adopted strategies to obtain hemostasis were prolonged balloon inflation (73.2%) with covered stent implantation (64.4%) in the DP group, and prolonged balloon inflation (53.8%) with coil embolization (41%) in the WP group. Procedural or in-hospital events arose in 38.2% of cases: mortality was higher after DP (7.2% vs 2.6%, p = 0.05) and acute stent thrombosis 3-fold higher (3.1% vs 0.9%, p = 0.19). At clinical follow-up, median 2 years, a major cardiovascular event occurred in one-third of cases (all-cause mortality 8.2% and 7.1% respectively, without differences between groups). In conclusion, although rare and despite improved rates of adequate perforation sealing G3-CAP cause significant adverse events. DP and WP result in different patterns of G3-CAP and management strategies should be based on this classification.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy; Montefiore Medical Center, New York, New York.
| | - Marco Pavani
- Cardiology Unit, Santissima Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Umberto Barbero
- Cardiology Unit, Santissima Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | | | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | - Francesco Tomassini
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | | | - Simone Calcagno
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, Rome, Italy
| | - Alfonso Franzè
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza di Torino, Turin, Italy; Montefiore Medical Center, New York, New York
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center and Virginia Commonwealth University, Richmond, Virginia
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, Rome, Italy
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
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9
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Birkemeyer R, Olivecrona GK, Hellig F, Wöhrle J, Rottbauer W, Witkowski A, Kuliczkowski W, Bernhardt P, Bettels N, Schrage B, von Zur Mühlen C, Cook S, Miljak T, Eggbrecht H, Eeckhout E, Westermann D, Monsegu J, Dumonteil N. Sealing of Coronary Perforations With a Second-Generation Covered Stent Graft - Results From the PAST-PERF Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:20-26. [PMID: 33132086 DOI: 10.1016/j.carrev.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The PAST-PERF registry was initiated to collect data on the PK Papyrus covered stent, a second-generation device for the treatment of coronary artery perforations with enhanced mechanical properties, but with limited available data. METHODS Patients treated for coronary artery perforations with the PK Papyrus stent at 14 international centers were retrospectively identified. The primary effectiveness outcome was successful sealing of the perforation. The primary safety outcome was a composite of all-cause mortality, definite or probable stent thrombosis, myocardial infarction and target lesion revascularization. RESULTS Among the 94 included patients, 72.3% (68/94) had Ellis type III and cavity spilling perforations. Complete sealing was achieved in 93.6% (n = 88), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). Pericardiocentesis was required in 25.0% (n = 23), emergency cardiac surgery was needed in 7.6% (n = 7), acute stent thrombosis was observed in 1.1% (n = 1), and in-hospital mortality occurred in 11.7% (n = 11). The median follow-up duration was 283 (IQR:40;670) days. At 6 and 12 months, the incidence of the primary safety endpoint was 26.6% [95%CI:18.6;37.1] and 32.0% [95%CI:22.8;43.4], mortality 15.0% [95%CI:9.0;24.6] and 19.0% [95%CI:11.3;30.0], and target lesion revascularization 5.5% [95%CI:2.0;14.6] and 7.7% [95%CI:3.1;18.2]. Two definite stent thrombosis occurred, one during the procedure and one on post-procedure day 233. CONCLUSIONS The registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. ANNOTATED TABLE OF CONTENT The PAST-PERF registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Specifically, complete sealing was achieved in 93.6% of patients (n = 88/94), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). The 12-month mortality was 19.0% [95%CI:11.3;30.0], the rate of target lesion revascularization was 7.7% [95%CI:3.1;18.2], and two definite stent thromboses occurred (one during procedure and one on post-procedure day 233).
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Affiliation(s)
| | | | | | - Jochen Wöhrle
- University Hospital Ulm, Ulm, Germany; Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Eric Eeckhout
- CHUV (Centre Hospitalier Universitaire Vaudoise), Lausanne, Switzerland
| | | | - Jaques Monsegu
- Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
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10
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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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11
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An atorvastatin calcium and poly(L-lactide-co-caprolactone) core-shell nanofiber-covered stent to treat aneurysms and promote reendothelialization. Acta Biomater 2020; 111:102-117. [PMID: 32442783 DOI: 10.1016/j.actbio.2020.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/05/2023]
Abstract
Aneurysmal subarachnoid hemorrhage is a common complication caused by an intracranial aneurysm that can lead to hemorrhagic stroke, brain damage, and death. Knowing this clinical situation, the purpose of this study was to develop a controlled-release stent covered with a core-shell nanofiber mesh, fabricated by emulsion electrospinning, for the treatment of aneurysms. By encapsulating atorvastatin calcium (AtvCa) in the inner of poly (L-lactide-co-caprolactone) (PLCL) nanofibers, the release period of AtvCa was effectively extended. The morphology and inner structure of the core-shell nanofibers were observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), respectively. The release of AtvCa from the nanofiber system continued for more than ten weeks without a significant initial burst release. The nanofiber mesh structure degraded gradually but maintained its fiber morphology before neovascularization. The results of this study further elucidated the reendothelialization mechanism of AtvCa by analyzing the nitric oxide (NO) expression from seeded HUVECs. The in vivo studies demonstrated that the PLCL-AtvCa covered stents were capable of separating the aneurysm dome from the blood circulation, leading to the abolishment of the aneurysm. Moreover, the AtvCa controlled release promoted the in vitro proliferation of HUVECs on the nanofiber meshes, and the PLCL-AtvCa covered stents induced in vivo neovascularization. STATEMENT OF SIGNIFICANCE: Intracranial aneurysms are pathological dilatations of blood vessels that have developed an abnormally weak wall structure, thus prone to rupture. Covered stents had been demonstrated to be a method for the treatment of intracranial aneurysm. We prepared a controlled-release stent covered with a core-shell nanofiber mesh, fabricated by emulsion electrospinning, which encapsulated atorvastatin calcium in the inner portion of nanofibers. The results of this study further elucidated the reendothelialization mechanism of AtvCa by analyzing the nitric oxide (NO) expression from seeded HUVECs. The generated AtvCa-load covered stents separated the aneurysm dome from the blood circulation, and keep long-term patency of the parent artery. But also induced neovascularization, thus provide further protection against recurrence of aneurysms after nanofiber meshes degradation.
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12
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Nagaraja V, Schwarz K, Moss S, Kwok CS, Gunning M. Outcomes of patients who undergo percutaneous coronary intervention with covered stents for coronary perforation: A systematic review and pooled analysis of data. Catheter Cardiovasc Interv 2019; 96:1360-1366. [PMID: 31850685 DOI: 10.1002/ccd.28646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/01/2019] [Accepted: 12/07/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This review aims to evaluate the adverse outcomes for patients after treatment with covered stents. BACKGROUND Coronary perforation is a potentially fatal complication of percutaneous coronary revascularization which may be treated using covered stents. Studies have evaluated long-term outcomes among patients who received these devices, but hitherto no literature review has taken place. METHODS We conducted a systematic review of adverse outcomes for patients after treatment with covered stents. Data from studies were pooled and outcomes were compared according to stent type. RESULTS A total of 29 studies were analyzed with data from 725 patients who received covered stents. The proportion of patients with chronic total occlusions, vein graft percutaneous coronary intervention (PCI), intracoronary imaging and rotational atherectomy were 16.9, 11.5, 9.2, and 6.6%, respectively. The stents used were primarily polytetrafluoroethylene (PTFE) (70%) and Papyrus (20.6%). Mortality, major adverse cardiovascular events, pericardiocentesis/tamponade and emergency surgery were 17.2, 35.3, 27.1, and 5.3%, respectively. Stratified analysis by use of PTFE, Papyrus and pericardial stents, suggested no difference in mortality (p = .323), or target lesion revascularization (p = .484). Stent thrombosis, pericardiocentesis/tamponade and emergency coronary artery bypass surgery (CABG) occurred more frequently in patients with PTFE stent use (p = .011, p = .005, p = .012, respectively). In-stent restenosis was more common with pericardial stent use (<.001, pooled analysis for first- and second-generation pericardial stents). CONCLUSIONS Cases of coronary perforation which require implantation of a covered stent are associated with a high rate of adverse outcomes. The use of PTFE covered stents appears to be associated with more stent thrombosis, pericardiocentesis/tamponade, and emergency CABG when compared to Papyrus or pericardial stents.
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Stuart Moss
- Orange Base Hospital, Orange, New South Wales, Australia
| | - Chun Shing Kwok
- School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK.,Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Gunning
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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13
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Colombo A, Mangieri A. Should we implant a covered stent only when there is no other solution? EUROINTERVENTION 2019; 14:1626-1627. [PMID: 30956185 DOI: 10.4244/eijv14i16a278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola (RA), Italy
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14
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Patel NJ, Heuser RR. Covered stents: A 25-year odyssey. Catheter Cardiovasc Interv 2019; 93:E189-E190. [DOI: 10.1002/ccd.28006] [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: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Nachiket J. Patel
- St. Luke's Medical Center; University of Arizona College of Medicine; Phoenix Arizona
| | - Richard R. Heuser
- St. Luke's Medical Center; University of Arizona College of Medicine; Phoenix Arizona
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Liu P, Liu Y, Li P, Zhou Y, Song Y, Shi Y, Feng W, Mo X, Gao H, An Q, Zhu W. Rosuvastatin- and Heparin-Loaded Poly(l-lactide- co-caprolactone) Nanofiber Aneurysm Stent Promotes Endothelialization via Vascular Endothelial Growth Factor Type A Modulation. ACS APPLIED MATERIALS & INTERFACES 2018; 10:41012-41018. [PMID: 30403126 DOI: 10.1021/acsami.8b11714] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored a new rosuvastatin calcium- and heparin-loaded poly(l-lactide- co-caprolactone) (PLCL) scaffold for covered stents for treating aneurysms. The mechanism of rosuvastatin-induced endothelialization via vascular endothelial growth factor (VEGF)-A elevation was further explored. Rosu50, Rosu75, Rosu100, and phosphate-buffered saline (PBS) nanofibrous scaffolds were fabricated by coaxial electrospinning and observed by electron microscopy. Anticoagulation and pro-endothelialization properties were tested. Sixteen rabbits were selected for an in vivo assay and underwent microsurgery to establish a carotid aneurysm model. The animals were treated with covered stents and followed for 4 months using digital subtraction angiography (DSA), electron microscopy, and histology. Rosuvastatin-treated human umbilical vein endothelial cell (HUVEC) viability, function, and VEGF-A modulation were further studied to elucidate the pro-endothelialization mechanism of rosuvastatin. Our study demonstrates that rosuvastatin and heparin can be incorporated into PLCL nanofibers via electrospinning. Rosu100 nanofiber scaffolds exhibited significant anticoagulation properties. The viability of HUVECs transferred to Rosu100 nanofiber scaffolds was increased significantly. In vivo, DSA revealed that the Rosu100 group had better outcomes than the PBS group. In addition, the Rosu100 stents induced more integrated endothelialization. Further study demonstrated that rosuvastatin promoted HUVEC viability and function in vitro. The effects of rosuvastatin may be attributed to an elevation in VEGF-A. We demonstrated that rosuvastatin- and heparin-loaded PLCL-covered stents show favorable anticoagulation and pro-endothelialization properties in vitro and in vivo in a rabbit aneurysm model. VEGF-A elevation played a crucial role in rosuvastatin-promoted endothelialization. This work provides an additional option for treating cerebral aneurysms with covered stents.
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Affiliation(s)
| | | | | | | | - Yaying Song
- Department of Neurology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai 200025 , China
| | | | - Wenhao Feng
- Key Laboratory of Science & Technology of Eco-Textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology , Donghua University , Shanghai 201620 , China
| | - Xiumei Mo
- Key Laboratory of Science & Technology of Eco-Textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology , Donghua University , Shanghai 201620 , China
| | - Hongyang Gao
- Electron Microscopy Core Laboratory, School of Basic Medical Sciences , Fudan University , Shanghai 200433 , China
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Tajti P, Xenogiannis I, Chavez I, Gössl M, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Burke MN, Brilakis ES. Expecting the unexpected: preventing and managing the consequences of coronary perforations. Expert Rev Cardiovasc Ther 2018; 16:805-814. [DOI: 10.1080/14779072.2018.1533402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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