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Chaturvedi A, Haberman D, Waksman R, Bernardo NL. Percutaneous intervention of a giant native coronary artery aneurysm using self-expanding stents. Catheter Cardiovasc Interv 2024. [PMID: 38860616 DOI: 10.1002/ccd.31112] [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: 01/10/2024] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
In the absence of standardized management guidelines, coronary artery aneurysms (CAAs) present therapeutic challenges. Percutaneous coronary intervention (PCI) is rarely explored, especially in giant aneurysms with persistent angina, where surgery might be presumed as a preferred option. We describe the technical aspects and feasibility of PCI using Gore Viabahn expanded polytetrafluoroethylene (ePTFE)-covered nitinol self-expanding stents in a 66-year-old woman with a complex medical history and an enlarging, symptomatic right coronary artery aneurysm. The case was complicated by endoleak after the first stent, but intravascular ultrasound guidance enabled the precise deployment of additional stents, resulting in the successful exclusion of the aneurysm. This case demonstrates steps to successful CAA PCI with Gore Viabahn ePTFE-covered nitinol self-expanding stents and emphasizes that in unsuitable surgical candidates, PCI might be a potential alternative for symptomatic CAAs.
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Affiliation(s)
- Abhishek Chaturvedi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Al Mawed M, Vlachojannis M, Pula A, Gielen S. Delayed coronary perforation four days after percutaneous coronary intervention with subsequent cardiac tamponade: A case report. Catheter Cardiovasc Interv 2023; 102:1061-1065. [PMID: 37855161 DOI: 10.1002/ccd.30861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/27/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
Coronary artery perforation (CAP) is a rare but lethal complication of percutaneous coronary interventions (PCIs), and its incidence has been increasing with advances in PCI techniques. Delayed CAP presents a highly challenging complication, as it occurs 30 min-9 days after intervention, making subsequent diagnosis and treatment difficult. We present the case of a 63-year-old male patient who underwent PCI for an obtuse marginalis II because of posterior wall myocardial infarction. Following 4 days of uneventful postoperative stay, the patient developed angina pectoris and hypotension 4 h after reinitiation of anticoagulant therapy with edoxaban. Angiography revealed distal vessel perforation from a side branch of the obtuse marginalis II. The vessel was occluded using autologous fat embolization via a microcatheter, resulting in complete sealing of the perforation. After discharge, 4 weeks after the infarction, the patient started rehabilitation therapy. Distal vessel perforations are typically caused by wire damage. In our case, we also suspected distal wire perforation, which was initially not recognized possibly due to distal occlusion through the thrombotic material. The temporal correlation between the re-initiation of anticoagulant therapy and the occurrence of cardiac tamponade suggests that the thrombotic material was resolved due to the former. The management of delayed CAP does not differ from that of CAP; thus, this rare complication should be considered even days after PCI as it could prove lethal if not recognized early.
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Affiliation(s)
- Mohammad Al Mawed
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold, North Rhine-Westphalia, Germany
| | - Marios Vlachojannis
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold, North Rhine-Westphalia, Germany
| | - Arianit Pula
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold, North Rhine-Westphalia, Germany
| | - Stephan Gielen
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold, North Rhine-Westphalia, Germany
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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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Naimi I, Morray B, Portman MA, Steinberg ZL. Use of the PK Papyrus covered coronary stent in the treatment of Kawasaki disease-associated giant coronary artery aneurysms. Catheter Cardiovasc Interv 2022; 100:1267-1272. [PMID: 36285531 DOI: 10.1002/ccd.30458] [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: 05/21/2022] [Revised: 08/25/2022] [Accepted: 10/02/2022] [Indexed: 01/04/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis that can cause coronary artery inflammation and aneurysm formation leading to early obstructive disease. We describe the use of PK Papyrus covered stents (Biotronic, Inc.) in three pediatric patients to exclude coronary artery aneurysms (CAA) from the circulation and relieve aneurysm associated stenoses. Follow-up angiography at 11-17 months postprocedure demonstrated persistent exclusion of CAA and varying degrees of in-stent restenosis (ISR). Two patients required percutaneous coronary intervention with drug eluting stent (DES) implantation to relieve in-stent stenosis. Our findings suggest that CAA exclusion with the PK Papyrus stent is possible and may be a valuable tool in simultaneously treating stenotic and thrombogenic CAA in pediatric KD patients. ISR of these non-DES remains an issue and may require additional interventions within the short-term to maintain vessel patency.
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Affiliation(s)
- Iman Naimi
- Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.,Dvision of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Brian Morray
- Dvision of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Michael A Portman
- Dvision of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
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Mézier A, Dauphin C, Souteyrand G, Motreff P. Unusual interventional treatment of a complex calcified coronary artery lesion in a child with Kawasaki disease: a case report. Eur Heart J Case Rep 2022; 6:ytac332. [PMID: 36131809 PMCID: PMC9486884 DOI: 10.1093/ehjcr/ytac332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022]
Abstract
Background Kawasaki disease (KD) is a medium vessel vasculitis occurring in children, as yet of undetermined aetiology. KD can lead to severe complications such as coronary artery aneurysms, thrombosis, and sudden death. Monitoring of coronary anomalies is an important issue in the early phase of the disease, and their follow-up is based on different imaging methods. The interventional treatment of these coronary anomalies, which is often complex, is a therapeutic challenge. Case summary We are reporting the case of a four-year-old child who presented KD which was complicated by coronary aneurysm of the proximal left anterior descending artery and ectasia of the right coronary artery (RCA). These lesions progressively calcified and resulted at the age of 13 in chronic occlusion of the RCA. After confirmation of myocardial viability and myocardial ischaemia, a complex angioplasty guided by intracoronary imaging was performed using rotational atherectomy, a cutting balloon, and a high pressure balloon. The control coronary angiography performed 1 year later revealed two false aneurysm on the RCA at the angioplasty site, which were successfully treated with a covered stent. Discussion This case report describes the challenges of treating coronary artery abnormalities such as calcified coronary lesions in children with KD. The coronary intervention of these lesions remains complex and may lead to coronary rupture. We highlight the advantage of using intracoronary imaging in the management of these calcified lesions for successful revascularization, and to assess the complications of percutaneous coronary intervention.
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Affiliation(s)
- Anthony Mézier
- Department of Cardiology, Gabriel Montpied University Hospital , 63000 Clermont-Ferrand , France
| | - Claire Dauphin
- Department of Cardiology, Gabriel Montpied University Hospital , 63000 Clermont-Ferrand , France
| | - Géraud Souteyrand
- Department of Cardiology, Gabriel Montpied University Hospital , 63000 Clermont-Ferrand , France
| | - Pascal Motreff
- Department of Cardiology, Gabriel Montpied University Hospital , 63000 Clermont-Ferrand , France
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Kandzari DE, Sarao RC, Waksman R. Clinical experience of the PK Papyrus covered stent in patients with coronary artery perforations: Results from a multi-center humanitarian device exemption survey. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:97-101. [DOI: 10.1016/j.carrev.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
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Clinical Outcomes following Large Vessel Coronary Artery Perforation Treated with Covered Stent Implantation: Comparison between Polytetrafluoroethylene- and Polyurethane-Covered Stents (CRACK-II Registry). J Clin Med 2021; 10:jcm10225441. [PMID: 34830722 PMCID: PMC8624773 DOI: 10.3390/jcm10225441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up.
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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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Wańha W, Januszek R, Kołodziejczak M, Kuźma Ł, Tajstra M, Figatowski T, Smolarek-Nicpoń M, Gruz-Kwapisz M, Tomasiewicz B, Bartuś J, Łoś A, Jagielak D, Roleder T, Włodarczak A, Kulczycki J, Kowalewski M, Hudziak D, Stachowiak P, Gorący J, Sierakowska K, Reczuch K, Jaguszewski M, Dobrzycki S, Smolka G, Bartuś S, Ochała A, Gąsior M, Wojakowski W. Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry. PLoS One 2021; 16:e0249698. [PMID: 33979357 PMCID: PMC8115813 DOI: 10.1371/journal.pone.0249698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). Results The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. Conclusions The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- * E-mail:
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michalina Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Tajstra
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Figatowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Malwina Smolarek-Nicpoń
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Monika Gruz-Kwapisz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Łoś
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | | | - Jan Kulczycki
- Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Paweł Stachowiak
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Jarosław Gorący
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | | | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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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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11
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Percutaneous Intervention of Coronary Aneurysm. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:138-142. [DOI: 10.1016/j.carrev.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
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12
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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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13
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Protty MB, Hussain HI, Gallagher S, Al‐Raisi S, Aldalati O, Farooq V, Sharp ASP, Egred M, O'Kane P, Ludman P, Anderson RA, Mamas MA, Kinnaird T. Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv 2020; 97:E653-E660. [DOI: 10.1002/ccd.29251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Majd B. Protty
- Department of Cardiology University Hospital of Wales Cardiff UK
- Systems Immunity University Research Institute Cardiff University Cardiff UK
| | | | - Sean Gallagher
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Sara Al‐Raisi
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Omar Aldalati
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Vasim Farooq
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Andrew S. P. Sharp
- Department of Cardiology University Hospital of Wales Cardiff UK
- Department of Cardiology University of Exeter Exeter Devon UK
| | - Mohaned Egred
- Cardiothoracic Department Freeman Hospital Newcastle‐Upon‐Tyne UK
| | - Peter O'Kane
- Department of Cardiology Bournemouth Hospital Bournemouth UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences University of Keele Stoke‐on‐Trent UK
| | - Tim Kinnaird
- Department of Cardiology University Hospital of Wales Cardiff UK
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences University of Keele Stoke‐on‐Trent UK
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14
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Jurado-Román A, Rodríguez O, Amat I, Romani SA, García-Touchard A, Cruz-González I, Benito-González T, Fernández-Cisnal A, Córdoba-Soriano JG, Subinas A, Hernández-Antolín R, Bayón J, García-Tejada J, Salinas P, Cortés C, Lozano F, Bastante T, Núñez-Gil IJ, Moreno R, López-Sendón JL. Clinical Outcomes After Implantation of Polyurethane-Covered Cobalt-Chromium Stents: Insights from the Papyrus-Spain Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 29:22-28. [PMID: 32859538 DOI: 10.1016/j.carrev.2020.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND/PURPOSE The main indication of covered stents (CS) is coronary artery perforation (CAP), but, they have been increasingly used in other scenarios. Data on the long-term follow-up of CS is limited, and no studies have been conducted specifically using new-generation polyurethane-covered cobalt-chromium Papyrus CS. PURPOSE to evaluate the clinical outcomes after hospital discharge of Papyrus CS and to compare their outcome after implantation in CAP or coronary artery aneurysms (CAA). METHODS/MATERIALS We evaluated the baseline clinical characteristics, lesion subsets, procedural features and the outcomes after initial discharge of Papyrus CS implanted in 17 high-PCI-volume centers. RESULTS 127 Papyrus CS were implanted in 108 patients (68 ± 1 years; 82.8% male) admitted for stable coronary disease (32.3%), NSTEMI (42.4%) or STEMI (25.3%). The number of CS per patient was 1.2 ± 0.6 (diameter: 3.5 ± 1.7 mm; length: 18.5 ± 3.7 mm). Angiographic success rate was 96%. CS diameter was larger in CAA (CAP:3.04 ± 0.5 mm vs CAA:4.1 ± 2.7 mm; p = .022). Intracoronary imaging techniques were used more frequently in CAA (p < .0001). After a mean follow-up of 22 ± 16 months, the major cardiovascular adverse events (MACE) rate was 7.1% [cardiac death: 2%, Myocardial infarction: 5%, Target Lesion Revascularization: 5% and Stent Thrombosis (ST): 3%]. MACE rate was similar in CAP (7.7%) and CAA (7.1%) (p = .9). However, CAA showed a higher ST rate (CAP: 0% vs CA: 7.1%; p = .04). CONCLUSION After hospital discharge, clinical outcomes after Papyrus CS implantation are acceptable (considering the clinical scenario and compared with other treatment alternatives) with no significant differences in the MACE rate between those implanted in CAA or in CAP. However, CAA group showed a higher ST rate.
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Affiliation(s)
| | - Oriol Rodríguez
- Cardiology Department, Germans Trias I Pujol Hospital, Badalona, Spain
| | - Ignacio Amat
- Cardiology Department, Hospital Clínico de Valladolid, Spain
| | | | | | | | | | | | | | - Asier Subinas
- Cardiology Department, University Hospital Galdakao, Spain
| | | | - Jeremías Bayón
- Cardiology Department, University Hospital Lucus Augusti, Lugo, Spain
| | | | - Pablo Salinas
- Cardiology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Cortés
- Cardiology Department, Hospital San Pedro de Logroño, Logroño, Spain
| | - Fernando Lozano
- Cardiology Department, University Hospital of Ciudad Real, Ciudad Real, Spain
| | - Teresa Bastante
- Cardiology Department, University Hospital La Princesa, Madrid, Spain
| | - Iván J Núñez-Gil
- Cardiology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
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15
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Harnek J, James SK, Lagerqvist B. Reply to the Letter to the Editor "Very long-term outcome of coronary covered stents. Not all covered stents are the same". EUROINTERVENTION 2020; 15:1298. [PMID: 32044734 DOI: 10.4244/eij-d-19-00364r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jan Harnek
- Department of Coronary Heart Disease and Institution of Clinical Sciences, Lund University, Lund, Sweden
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16
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Jurado-Román A, Jiménez-Valero S, Galeote G, Moreno R, López-Sendón JL. Very long-term outcome of coronary covered stents. Not all covered stents are the same. EUROINTERVENTION 2020; 15:1297. [DOI: 10.4244/eij-d-19-00364l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Harnek J, James S, Lagerqvist B. Coronary Artery Perforation and Tamponade - Incidence, Risk Factors, Predictors and Outcomes From 12 Years' Data of the SCAAR Registry. Circ J 2019; 84:43-53. [PMID: 31813890 DOI: 10.1253/circj.cj-19-0757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incidence and short- and long-term outcomes of coronary artery perforation (CAP) are not well described.Methods and Results:We analyzed the characteristics and the short- and long-term outcomes of CAP among 243,149 patients undergoing percutaneous coronary interventions (PCI) from 2005 until 2017 in the national Swedish registry. We identified 1,008 cases of CAP with an incidence of 0.42%. Major adverse event rates were significantly higher in patients with CAP than non-CAP (P<0.001). The 1-year mortality rate was 16% vs. 5.5%, respectively, and the 12-year mortality rate was 52% vs. 34%. The restenosis rate was 5.2% vs. 3.1% and 17% vs. 9%, respectively. The target lesion revascularization rate was 4.2% vs. 2.6% and 10.5% vs. 7%. The stent thrombosis rate was numerically higher, 1.5% vs. 0.8% and 4.5 vs. 2.8%, with no stent thrombosis cases for equine pericardial stent grafts. Among the patients with tamponade a large proportion of cases occurred at the late stage (215/1,008, 21%), and most were not recognized in the cath-lab (167/215, 78%). The mortality rate for late tamponade was similar in patients suffering acute tamponade at 1 year (25.6% vs. 27%) or at 12 years (54% vs. 58%). CONCLUSIONS CAP is associated with an early high excess in morbidity and mortality but with low risk of additional adverse events in the long term. Late tamponade is as deadly as acute tamponade.
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Affiliation(s)
- Jan Harnek
- Department of Coronary Heart Disease and Institute of Clinical Sciences, Lund University
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology, Uppsala University
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18
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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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19
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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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