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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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2
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Layer-by-layer biofabrication of coronary covered stents with clickable elastin-like recombinamers. Eur Polym J 2019. [DOI: 10.1016/j.eurpolymj.2019.109334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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3
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Romaguera R, Waksman R. Covered stents for coronary perforations: is there enough evidence? Catheter Cardiovasc Interv 2011; 78:246-53. [PMID: 21766425 DOI: 10.1002/ccd.23017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/22/2011] [Indexed: 11/09/2022]
Abstract
Covered stents have shown discouraging results when tested on saphenous vein grafts and when attempting to prevent restenosis on native coronary arteries. However, covered stents seem to be a unique tool when a coronary artery perforation complicates percutaneous coronary intervention. Because a randomized clinical trial is not likely to be conducted in this bail-out scenario, the data supporting its use come from case reports and small-size retrospective studies. This review summarizes the available evidence supporting the use of covered stents to treat coronary perforations.
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Affiliation(s)
- Rafael Romaguera
- Division of Cardiology, Washington Hospital Center, Washington, District of Columbia 20010, USA
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4
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Kawano H, Arakawa S, Satoh O, Matsumoto Y, Hayano M, Miyabara S. Foreign body granulomatous change from absorbable gelatin sponge and microcoil embolization after a guidewire-induced perforation in the distal coronary artery. Intern Med 2010; 49:1871-4. [PMID: 20823648 DOI: 10.2169/internalmedicine.49.3750] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report an autopsy case of treatment by absorbable gelatin sponge and microcoil embolization after perforation of the distal coronary artery by guidewire. Histological examination revealed a foreign body granuloma in the coronary artery with embolization. Foreign body reaction to absorbable gelatin sponge seemed to be stronger than that to the microcoil.
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MESH Headings
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Anticoagulants/therapeutic use
- Autopsy
- Coronary Vessels/injuries
- Coronary Vessels/pathology
- Embolization, Therapeutic/adverse effects
- Embolization, Therapeutic/instrumentation
- Gelatin Sponge, Absorbable/adverse effects
- Granuloma, Foreign-Body/etiology
- Granuloma, Foreign-Body/pathology
- Heart Failure/etiology
- Hemostatic Techniques
- Humans
- Male
- Stents
- Wounds, Penetrating/etiology
- Wounds, Penetrating/therapy
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiology, Nagasaki Rosai Hospital, Japan.
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5
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Godino C, Sharp ASP, Carlino M, Colombo A. Crossing CTOsâThe tips, tricks, and specialist Kit that can mean the difference between success and failure. Catheter Cardiovasc Interv 2009; 74:1019-46. [PMID: 19950136 DOI: 10.1002/ccd.22161] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/methods
- Chronic Disease
- Clinical Competence
- Coronary Occlusion/pathology
- Coronary Occlusion/therapy
- Coronary Vessels/injuries
- Equipment Design
- Heart Injuries/etiology
- Heart Injuries/prevention & control
- Humans
- Patient Selection
- Prosthesis Design
- Radiography, Interventional
- Rupture
- Stents
- Treatment Failure
- Treatment Outcome
- Ultrasonography, Interventional
- Wounds, Penetrating/etiology
- Wounds, Penetrating/prevention & control
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Affiliation(s)
- Cosmo Godino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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6
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Yeo KK, Rogers JH, Laird JR. Use of stent grafts and coils in vessel rupture and perforation. J Interv Cardiol 2008; 21:86-99. [PMID: 18254790 DOI: 10.1111/j.1540-8183.2007.00302.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vessel rupture and perforation are important complications of percutaneous treatment of coronary and peripheral arterial disease. These complications can result in abrupt vessel closure, distal organ injury, bleeding into the surrounding tissue, and death. Prompt management of such complications is therefore critically important. This paper reviews the management of vessel rupture and perforation, including the use of different types of covered stents (balloon-expandable and self-expanding), as well as the various types of embolization coils. Particular focus will be placed on percutaneous coronary artery and peripheral arterial interventions.
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Affiliation(s)
- Khung Keong Yeo
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
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7
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Martí V, Castaño C, Guiteras P, Vallés E, Domínguez de Rozas JM, Augé JM. Perforación coronaria complicada con taponamiento cardíaco sellada mediante coils metálicos. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77228-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Veselka J, Tesar D, Honek T, Burkert J. Treatment of recurrent coronary rupture by implantation of three coronary stent-grafts. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 5:88-91. [PMID: 12745866 DOI: 10.1080/14628840310003299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors report a case of recurrent left anterior descending artery rupture during coronary interventions in a 70-year-old man. Coronary artery rupture was treated successfully by percutaneous coronary stent-graft implantation. Based on this experience, the authors advise against repeat angioplasty of a coronary artery which has ruptured during a prior intervention. Membrane-covered stents should be the first choice in the treatment of life-threatening coronary artery rupture.
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Affiliation(s)
- Josef Veselka
- Department of Cardiac Surgery, University Hospital Motol, Prague, Czech
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9
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Störger H. Incidence, prevention, and treatment of vascular perforations complicating coronary interventions. J Interv Cardiol 2002; 15:505-10. [PMID: 12476655 DOI: 10.1111/j.1540-8183.2002.tb01096.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hans Störger
- Kardiologisches Centrum, Rot Kreuz Krankenhaus, Pfingstweidstr. 11, 60316 Frankfurt, Germany.
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10
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Fukutomi T, Suzuki T, Popma JJ, Hosokawa H, Yokoya K, Inada T, Hayase M, Kondo H, Ito S, Suzuki S, Itoh M. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. Circ J 2002; 66:349-56. [PMID: 11954948 DOI: 10.1253/circj.66.349] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary perforation is a rare but serious complication that occurs during percutaneous coronary intervention (PCI). This study examines the frequency of coronary perforation during PCI, evaluates the management strategies used to treat perforations, and describes the long-term prognosis of patients who have developed coronary perforation during PCI. Coronary perforations were found in 69 (0.93%) of 7,443 consecutive PCI procedures, occurring more often after use of a new device (0.86%) than after use of balloon angioplasty (0.41%) (p<0.05). Coronary perforation was attributable solely to the coronary guidewire in 27 (0.36%) cases. Coronary perforations were divided into 2 types: (1) Those with epicardial staining without ajet of contrast extravasation (type I, n=51), and (2) those with a jet of contrast extravasation (type II, n= 18). Patients with type I and type II perforations were managed by observation only (35% and 0%, respectively), reversal of anticoagulation (57% and 94%), pericardiocentesis and drainage (27% and 61%), and prolonged perfusion balloon angioplasty (16% and 100%). Two patients with type II perforations required emergency coronary artery bypass surgery. There were no in-hospital deaths. Late pseudoaneurysms developed in 18 (28.6%) patients during the 13.4 +/- 11.3 months' follow-up period, and were more common in patients with type II perforations (72.2% vs 11.1% with type I perforations; p<0.001). During the follow-up period, no patient had evidence of coronary rupture. The results suggest that coronary perforation is uncommon after PCI, and can be managed without cardiac surgery in the majority of cases. Late pseudoaneurysms developed in some patients, particularly in patients with type II perforations, but there were no late consequences of coronary perforation after PCI.
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Affiliation(s)
- Tatsuya Fukutomi
- The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Aichi, Japan.
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11
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Stefanadis C, Toutouzas K, Tsiamis E, Toutouzas P. New stent design for autologous venous graft-covered stent preparation: first human application for sealing of a coronary aneurysm. Catheter Cardiovasc Interv 2002; 55:222-7. [PMID: 11835652 DOI: 10.1002/ccd.10087] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this case report, we present the first clinical application of a new stent design for autologous venous graft-covered stent preparation. This stent consists of a main body, resembling the configuration of conventional stents, and two connecting arms at the edges of the stent for the stabilization of the venous graft on the external surface of the stent. This new stent design was applied in a patient with an aneurysm in a stented segment in the right coronary artery. The immediate and long-term angiographic evaluation after the covered stent implantation showed complete sealing of the aneurysm without restenosis.
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Affiliation(s)
- Christodoulos Stefanadis
- Department of Cardiology, Athens Medical School, 9 Tepeleniou Street, 15452 Paleo Psychico, Athens, Greece.
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12
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Kereiakes DJ, Broderick TM, Howard WL, Anderson LC, Weber M, Mitts DL. Successful long-term therapy following saphenous vein-covered stent deployment for atherosclerotic coronary aneurysm. Catheter Cardiovasc Interv 2002; 55:100-4. [PMID: 11793504 DOI: 10.1002/ccd.10064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.
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Affiliation(s)
- Dean J Kereiakes
- The Lindner Center for Research and Education, Ohio Heart Health Center, Cincinnati, Ohio 45219, USA.
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13
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Pienvichit P, Waters J. Successful closure of coronary artery perforation using makeshift stent sandwich. Catheter Cardiovasc Interv 2001; 54:209-13. [PMID: 11590686 DOI: 10.1002/ccd.1269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An elderly woman underwent stenting of mid left anterior descending coronary artery (LAD) 2 days after myocardial infarction. During high-pressure stent dilatation, vessel perforation was noted. We assembled a "stent sandwich" in the cardiac catheterization laboratory and used it successfully to seal the perforation with good angiographic result. Although the long-term patency remains an issue, this case demonstrates the feasibility of using makeshift covered-stent as a bailout for arterial perforation in selected cases where emergency thoracotomy is undesirable.
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Affiliation(s)
- P Pienvichit
- Division of Cardiology, Department of Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.
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14
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Briguori C, Sarais C, Colombo A. The polytetrafluoroethylene-covered stent: a device with multiple potential advantages. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2001; 4:145-149. [PMID: 12036469 DOI: 10.1080/146288401753514506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The polytetrafluoroethylene (PTFE)-covered stent has emerged in the past year as a device with multiple potential advantages. Its structure (a sandwich composed of a layer of PTFE membrane between two stents) makes this the ideal tool for treating coronary ruptures, and for excluding coronary aneurysms. Furthermore, this device may be useful in the treatment of aortocoronary vein graft stenosis. In the present review, the authors summarize experiences with covered stents, and focus attention on available data on the implantation of PTFE-covered stents in human beings to treat coronary ruptures, aneurysms and aortocoronary vein graft stenosis.
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Affiliation(s)
- Carlo Briguori
- Laboratory of Interventional Cardiology, 'Vita-Salute' University School of Medicine, San Raffaele Hospital, Milan, Italy
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15
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Yoo BS, Yoon J, Lee SH, Kim JY, Lee HH, Ko JY, Lee BK, Hwang SO, Choe KH. Guidewire-induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol form. Catheter Cardiovasc Interv 2001; 52:231-4. [PMID: 11170336 DOI: 10.1002/1522-726x(200102)52:2<231::aid-ccd1055>3.0.co;2-q] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe a first case of successful transcatheter management of guidewire-induced distal coronary artery perforation and impending cardiac tamponade, which developed during percutaneous coronary angioplasty, with transcatheter injection of polyvinyl alcohol form. This method may be an effective alternative in the management of distal coronary artery perforation requiring surgical repair.
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Affiliation(s)
- B S Yoo
- Cardiology Section, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
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16
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Ruiz-Nodar J M, Mainar V, Bordes P, Jordán A. [Repair of saphenous vein perforation with covered stent during angioplastic]. Rev Esp Cardiol 2001; 54:120-2. [PMID: 11141464 DOI: 10.1016/s0300-8932(01)76274-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Coronary perforation or rupture is an infrequent complication of angioplasty which may have a poor prognosis and influence patient survival. Cardiac tamponade or the presence of ischemia leading to acute myocardial infarction may require emergency cardiac surgery. Surgical treatment of perforation or rupture of the coronary arteries is based on prolonged inflation with angioplasty balloons or autoperfusion. There are few studies on the placement of covered stents to seal the perforation. We present the case of a patient who presented saphenous vein graft rupture following high pressure stent implantation requiring percutaneous placement of a covered stent.
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Affiliation(s)
- M Ruiz-Nodar J
- Sección de Hemodinámica. Hospital General de Alicante.*Servicio de Cardiología. Hospital de Elche.
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17
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Abstract
A guidewire-induced distal coronary artery perforation presenting with cardiac tamponade was occluded by distal Gelfoam embolization via an infusion catheter. This extends the treatment options for this rare complication of coronary interventional procedures. Cathet. Cardiovasc. Intervent. 49:214-217, 2000.
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Affiliation(s)
- S R Dixon
- Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
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18
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STÖRGER HANS, HAASE JÜRGEN. Polytetrafluoroethylene-Covered Stents: Indications, Advantages, and Limitations. J Interv Cardiol 1999. [DOI: 10.1111/j.1540-8183.1999.tb00674.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Schöbel WA, Voelker W, Haase KK, Karsch KR. Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. Catheter Cardiovasc Interv 1999; 47:341-6. [PMID: 10402295 DOI: 10.1002/(sici)1522-726x(199907)47:3<341::aid-ccd22>3.0.co;2-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.
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Affiliation(s)
- W A Schöbel
- Department of Cardiology, University of Tübingen, Tübingen, Germany.
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Lotze U, Ferrari M, Dannberg G, Kühnert H, Figulla HR. Unexpanded, irretrievable stent in the proximal right coronary artery: successful management with stent graft implantation. Catheter Cardiovasc Interv 1999; 46:344-9. [PMID: 10348137 DOI: 10.1002/(sici)1522-726x(199903)46:3<344::aid-ccd19>3.0.co;2-m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stent loss and failure of retrieval are rare; nevertheless, complications have to be taken into account during percutaneous coronary intervention. Here we report a case of an unexpanded, irretrievable Palmaz-Schatz stent in the proximal right coronary artery near to the ostium and the successful management by implanting a synthetic stent graft.
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Affiliation(s)
- U Lotze
- Department of Internal Medicine III, Friedrich-Schiller-Universität, Jena, Germany. lotze@.polkim.med.uni-jena.de
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Abstract
Devices used in interventional radiology have significantly developed in the past few years. In order to understand the trends of this development, we analyzed how new interventional devices are progressively incorporating materials having original physical properties, and how developers are today progressively turning towards biomaterials, with respect to the new regulatory environment, and the requirements of biocompatibility.
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Affiliation(s)
- A Laurent
- Centre de Recherche en Imagerie Interventionnelle (Cr2i), APHP-INRA, Jouy-en-Josas, France
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22
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HAUSDORF GERD. Future Uses of Stents. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00149.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Abstract
Spontaneous rupture of coronary arteries as well as coronary perforation during percutaneous interventions are rare but potentially life-threatening incidents often resulting in emergency surgery. Frequency of acute perforation due to therapeutic catheterization varies according to the devices employed. With conventional balloon angioplasty it is estimated to be 0.1 to 0.2% whereas substantially higher rates of up to 3% have been reported with the use of so-called "new devices" (i.e. directional atherectomy, rotablation, excimer laser angioplasty or extractional atherectomy). Interventional strategies for nonsurgical treatment of acute coronary perforations during catheterization procedures have been developed. In recent times, availability of coronary stent-grafts allows for a percutaneous resolution of acute perforations while maintaining vessel patency. Whereas iatrogenic perforations in the catheterization laboratory may thus be treated immediately at the site of their occurrence, rupture of pre-existing but potentially unknown coronary pathology frequently is associated with a diagnostic interval, giving rise to serious clinical events (i.e. myocardial infarction, cardiac tamponade, malign arrhythmias or sudden death). It may be warranted to advocate prophylactic treatment of rupture-prone coronary conditions even on incidental diagnosis. This can either be performed by cardiothoracic surgery or, in suitable cases, by interventional therapy. Implantation of coronary stent-grafts could prove to become the therapy of choice due to its technical facility, safety and the short length of hospital stay associated with it. Before general recommendations can be made, however, as to the extension of indication for these novel coronary devices, further clinical studies encompassing long-term clinical and angiographic follow-up are needed.
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Affiliation(s)
- M Elsner
- Medizinische Klinik IV (Kardiologie/Nephrologie), Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt a. M.
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