title: Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft.
abstract: Coronary artery perforation is a rare, but dreaded, complication of percutaneous coronary intervention. Conventional treatment, including reversal of anticoagulation and prolonged balloon inflation, is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Although a number of case reports have demonstrated the feasibility of sealing coronary perforations with synthetic material-covered stent grafts, the efficacy of this treatment has not been reported in a large, multicenter series. We used a retrospective international registry to examine the outcomes of the polytetrafluoroethylene-coated JOSTENT coronary stent graft (CSG) in 41 cases of coronary perforations. Perforations were relatively severe: 16.7% Ellis grade 1, 54.2% grade 2, and 29.1% grade 3. Of the 41 patients, > 1/3 (n = 14) experienced life-threatening complications before stent graft implantation, including pericardial tamponade (12.2%), cardiogenic shock (9.8%), and cardiac arrest (2.4%). A total of 52 CSGs were used to treat the 41 perforations (mean 1.3 per lesion). All CSGs were placed successfully, with 92.9% of the perforations sealed completely and 7.1% partially. One patient developed abrupt vessel closure after CSG deployment, resulting in an overall procedure success rate of 96.4%. No in-hospital Q-wave myocardial infarctions, emergency coronary bypass surgeries, or deaths resulted. The CSG may be a reliable and highly effective treatment option for sealing coronary perforations complicating percutaneous coronary interventions.
authors.affiliation: Cardiovascular Research Foundation, New York, New York, USA. alansky@crf.org
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Yi-ming
authors.initials: YM
authors.lastname: Yang
authors.forename: Yosef
authors.initials: Y
authors.lastname: Khan
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Cody
authors.initials: C
authors.lastname: Pietras
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsuchiya
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002932:Cineangiography; D020099:Coated Materials, Biocompatible; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene; D011379:Prognosis; D011474:Prosthesis Design; D012189:Retrospective Studies; D012421:Rupture; D015607:Stents
chemical_list: D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene