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Jurado-Román A, Tébar-Márquez D, Hernandez-Enríquez M, Birkemeyer R, Rodríguez-Leor O, Spinu R, Belle L, Galeote G, Jiménez-Valero S, Moreno R. Meta-long Papyrus: Meta-analysis of mid to long-term outcomes of PK Papyrus covered stent. Catheter Cardiovasc Interv 2024. [PMID: 39033331 DOI: 10.1002/ccd.31157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/26/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Although covered stents (CS) represent a potentially life-saving intervention for coronary perforation (CAP), their application has expanded to other contexts, including coronary aneurysms (CAA). However, data regarding mid- and long-term outcomes of CS in these settings scenarios remains limited. AIMS This meta-analysis aims to evaluate major adverse cardiac events (MACE) from discharge through long-term follow-up in patients undergoing percutaneous coronary intervention with the new generation polyurethane-covered cobalt-chromium PK Papyrus CS. METHODS We conducted a meta-analysis of data from three observational trials that included long-term follow-up of patients who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus, and PAST-PERF registry. RESULTS 332 patients underwent PK Papyrus CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for other indications. After a mean follow-up of 16.2 months, the MACE was 14.3%, with Target Lesion Revascularization (TLR) being the most frequent (8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD), 2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015). CONCLUSIONS The clinical outcomes following PK Papyrus CS implantation are deemed acceptable, considering the challenging scenarios and the existing alternative treatments. However, MACE rates in patients with CAA who received Papyrus PK CS were significantly higher than in those with CAP, underscoring the importance of meticulous patient selection and optimization of CS in these complex patients and coronary anatomies.
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Affiliation(s)
- Alfonso Jurado-Román
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Daniel Tébar-Márquez
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | | | | | | | - Radu Spinu
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Loïc Belle
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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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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Rizza A, Negro F, Scalera S, Palmieri C, Santoro G, Berti S. Total Endovascular Treatment of Ascending Aorta Pseudoaneurysm After Bentall Procedure. JACC: CASE REPORTS 2023; 10:101764. [PMID: 36974053 PMCID: PMC10039386 DOI: 10.1016/j.jaccas.2023.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 03/17/2023]
Abstract
Ascending aorta pseudoaneurysms represent uncommon but life-threatening complications that can be observed even after a long time in patients who have undergone aortic surgery. We describe an interesting case of a patient with ascending aorta pseudoaneurysm after the Bentall procedure treated with endovascular coil embolization from the right coronary artery. (Level of Difficulty: Intermediate.).
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Mouchli AY, Chaugle H, Byrne JG. Technique for Salvage Reconstruction of Shredded Left Main Coronary Artery after Rotablator Injury. Ann Thorac Surg 2022; 115:e109-e111. [PMID: 35504362 DOI: 10.1016/j.athoracsur.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
Abstract
We report the technique needed to effectively repair a left main coronary artery shredding after rotational atherectomy and destruction of the left main coronary artery. The patient had been deemed inoperable at another center because of diffuse distal coronary disease. The complication led to cardiac tamponade and hemodynamic collapse, necessitating cardiopulmonary resuscitation and salvage surgery. This is perhaps the first case in the literature to show a successful repair of such a complex and significant left main, left anterior descending, and left circumflex coronary artery rupture in a patient in extremis.
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Affiliation(s)
| | | | - John G Byrne
- HCA Houston Healthcare Clear Lake, Houston, Texas
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Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
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Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
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Outcomes of patients who undergo elective covered stent treatment for coronary artery aneurysms. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:91-96. [PMID: 34034989 DOI: 10.1016/j.carrev.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coronary artery aneurysms (CAA) are reported in up to 5% of patients undergoing coronary angiography. Treatment of CAAs with covered stents has been reported in several case reports, however there is limited evidence available on the effectiveness and safety of this interventional practice. PURPOSE To evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents. METHODS We conducted a systematic review of published case reports and case series of patients presenting with CAA that have been treated with covered stents in a non-emergency setting. RESULTS A total of 63 case reports and 3 case series were included in the final analysis comprising data from 81 patients. The treated CAA was situated in a native coronary artery in 92.6%, and in a saphenous vein graft in 7.4%. Procedural success was achieved in 95.1%. The types of stents used were mainly polytetrafluoroethylene (75.3%) and Papyrus (11.1%). In 11.0% of cases additional abluminal drug eluting stents (DES) and in 6.8% additional adluminal DES were implanted. After a mean follow up of 13.4 months overall major adverse cardiovascular events (MACE), mortality, myocardial infarction, stroke, stent thrombosis and target lesion revascularization were reported in 26.2, 0.0, 7.6, 0.0, 4.6 and 18.5% of cases, respectively. CONCLUSIONS The use of covered stents for elective treatment of CAA appears to be effective and reasonably safe. Nevertheless, it is associated with higher MACE rate, driven mainly by higher target lesion revascularization. Further studies, particularly in form of randomized trials and controlled registries are warranted to identify patients who might profit the most from this procedure.
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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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Elison D, Dean LS. Cover up: Clinic outcomes of covered stent usage for coronary perforation during PCI. Catheter Cardiovasc Interv 2021; 96:1367-1368. [PMID: 33306875 DOI: 10.1002/ccd.29400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
Coronary artery perforation is an uncommon, but potentially devastating, complication of PCI, and is observed most frequently in complex procedures. Clinical outcomes, including periprocedural and long-term mortality, are markedly worse with increasing degree of perforation. Perforation required covered stent usage predicts a high in-hospital and overall mortality, although no difference is noted between covered stent type.
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Affiliation(s)
- David Elison
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Larry S Dean
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Megaly M, Zordok M, Mentias A, Chugh Y, Buttar RS, Basir MB, Burke MN, Karmpaliotis D, Azzalini L, Alaswad K, Brilakis ES. Complications and failure modes of covered coronary stents: Insights from the MAUDE database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:157-160. [PMID: 34052127 DOI: 10.1016/j.carrev.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on the mechanisms of failure of covered coronary stents [Graftmaster, PK Papyrus] are limited. METHODS We queried the "Manufacturer and User Facility Device Experience" (MAUDE) database between August 2018 (when the PK Papyrus stent was FDA approved) and December 2020 for reports on covered coronary stents. RESULTS We identified 299 reports in the MAUDE database (after excluding duplicates, peripheral vascular reports, and incomplete records) (Graftmaster n = 225, PK Papyrus n = 74). The most common mechanism of failure of covered stents was failure to deliver the stent (46.2%), followed by stent dislodgement (22.4%) and failure to seal the perforation (19.7%). Failure to deliver the stent was more often reported with Graftmaster compared with PK Papyrus (59.1% vs. 6.8%, p < 0.001). Stent dislodgement was more often reported with PK Papyrus compared with Graftmaster (75.7% vs. 4.9%, p < 0.001) and was managed by device retrieval or by crushing the stent. CONCLUSIONS The most common failure mechanisms of covered stents are failure of delivery, stent dislodgement, and failure to seal the perforation. Failure of delivery was more common with Graftmaster, while stent dislodgement was more common with PK Papyrus. Further improvements in covered stent design are needed to optimize deliverability and minimize the risk of complications.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center/University of Arizona, Phoenix, AZ, United States of America
| | - Magdi Zordok
- Department of Medicine, Steward Carney Hospital, Boston, MA, United States of America
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Yashasvi Chugh
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Rupinder S Buttar
- Department of Medicine, Rochester Regional Health, Rochester, NY, United States of America
| | - Mir B Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Dimitrios Karmpaliotis
- Department of Cardiovascular Medicine, Columbia University, New York, NY, United States of America
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Khaldoon Alaswad
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
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Tremmel JA. Perforation Mechanisms, Risk Stratification, and Management in the Non-post Coronary Artery Bypass Graft Patient. Interv Cardiol Clin 2020; 10:93-99. [PMID: 33223111 DOI: 10.1016/j.iccl.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer A Tremmel
- Stanford University Medical Center, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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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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Hooda A, Masoomi R, Jain T, Johal GS, Barman N, Sharma SK. Rotational Atherectomy Induced Coronary Perforation of Right Coronary Artery Draining into Middle Cardiac Vein. JACC Case Rep 2020; 2:1688-1691. [PMID: 34317035 PMCID: PMC8312102 DOI: 10.1016/j.jaccas.2020.07.020] [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: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
Ellis Type III cavity spilling coronary perforation is a rare complication. We report to our knowledge, the first case of rotational atherectomy induced Type III cavity spilling coronary perforation of right posterior descending artery draining into middle cardiac vein, successfully managed by covered stent deployment. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Amit Hooda
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Reza Masoomi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tarun Jain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gurpreet S Johal
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nitin Barman
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Öner A, Moerke C, Wolff A, Kischkel S, Schmidt W, Grabow N, Ince H. A preclinical animal model for evaluating the sealing capacity of covered stent grafts in acute vessel perforation. Eur J Med Res 2020; 25:28. [PMID: 32727596 PMCID: PMC7392678 DOI: 10.1186/s40001-020-00429-y] [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: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background Percutaneous coronary intervention is among the most common therapeutic interventions in cardiology. This procedure may, however, be associated with a rare, though life-threatening complication: acute coronary perforation (CP). CP is primarily treated using covered stents, which are made of bare metal stents with a polytetrafluoroethylene (PTFE) or polyurethane coating. These stents’ major limitations include higher rates of thrombus formation and restenosis. Hence, there is a still unmet need for new stents regarding their design and composition. Or, to test new covered stent designs, the rabbit iliac artery has become the best-established animal model. This study sought to present a preclinical animal approach designed to test covered stents that are utilized following vessel perforation. Methods The animal experiments were performed using New Zealand white rabbits, each weighting 3.5–4.5 kg. The animal models described herein relied on the three most common clinical causes for CP, such as guidewire-induced, balloon catheter bursting, and device oversizing. Moreover, the sealing capacity of covered stent grafts was assessed for each of these models by means of angiography. Results We herein report a rabbit iliac artery perforation model using three different types of vessel perforation that closely mimic the clinical setting, such as guidewire-induced, balloon catheter rupture, and device oversizing. Using the same rabbit iliac perforation model, we additionally assessed the sealing capacity of a covered stent graft for each model. Conclusions The novel rabbit iliac artery perforation models, as described in this report, represent promising animal testing approaches. While their setting is very similar to the real-life context encountered in humans, all three models are based on an animal model that is ideally suited for evaluating the sealing capacity and performance of new medical devices for humans.
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Affiliation(s)
- Alper Öner
- Department of Cardiology, Rostock University Medical Center, Rostock, Germany. .,Medizinische Klinik I im Zentrum für Innere Medizin (ZIM), Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Caroline Moerke
- Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Anne Wolff
- Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Sabine Kischkel
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Wolfram Schmidt
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Hüseyin Ince
- Department of Cardiology, Rostock University Medical Center, Rostock, Germany
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