Optical coherence tomographic observations of polytetrafluoroethylene-covered sirolimus-eluting coronary arterial stent

Acute and long-term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3-CAP registry

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.

Coronary covered stents

Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.

Serial endovascular assessment of polytetrafluoroethylene-covered stent: Capabilities and limitations of intravascular imaging modalities affected by a temporal factor

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.>.