Key result
Self-made polyurethane-covered stent implantation for coronary artery perforation achieved a 79.2% procedural success rate, with a 27.3% MACE rate over long-term follow-up.
Why the study?
Commercial covered stents for urgent coronary artery perforation during PCI are not immediately available in some catheterization laboratories.
Does self-made polyurethane-covered stent implantation effectively seal coronary artery perforations and improve clinical outcomes in patients undergoing PCI?
Cohort (n=24)
No
Does self-made polyurethane-covered stent implantation effectively seal coronary artery perforations and improve clinical outcomes in patients undergoing PCI?
Self-made polyurethane-covered stents represent a feasible and effective rescue strategy for severe coronary artery perforations during PCI when commercial covered stents are not immediately available.
May support use as rescue when commercial stents unavailable; leaves open need for randomized trials on safety and efficacy.
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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Song et al. (2021) conducted a cohort in Coronary artery perforation during percutaneous coronary intervention (n=24). Self-made polyurethane-covered stents (PU-CS) was evaluated on Procedural success to seal the perforation. Self-made polyurethane-covered stent implantation for coronary artery perforation achieved a 79.2% procedural success rate, with a 27.3% MACE rate over long-term follow-up.
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