A Case Series of Eight Coronary Artery Perforations and a Review of the Up-to-Date Literature

James, Sunil; Hunter, G. C.

doi:10.33590/emjcardiol/21-00084

Cited by 2 publications

(3 citation statements)

References 13 publications

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“…Overcoming significant challenges and with the aid of a Guidezilla guide extension, an overlapping stent was positioned between the patient's previous proximal and midvessel stents using a 2.75×22.00 mm Onyx stent and optimized with a 3.25 mm non-compliant balloon. The procedure was successful, with no pericardial effusion observed during the procedure or on subsequent repeat echocardiography [23].…”

Section: Discussionmentioning

confidence: 81%

“…The second DES strategy for treating CAP in the main vessel is not commonly used, primarily due to the favorable immediate outcomes associated with PTFE covered stents [20]. According to a recent survey conducted by Dr. Johnson, fewer than 1% of physicians would opt for the second DES strategy to address CAP in the proximal main vessel [21][22][23]. However, in a report by Strycek and colleagues in May 2023, successful treatment of CAP with a second DES was documented.…”

Section: Discussionmentioning

confidence: 99%

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Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective?

Munirwan,

Hadi,

Purnawarman

et al. 2024

Narra J

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Coronary artery perforation (CAP) is an uncommon yet serious complication. Although severe perforations (Ellis III) have become more frequent, the overall mortality rate associated with perforations (7.5%) has decreased in recent years. Unfortunately, our medical facility cannot always access a cover stent. The aim of this case report was to demonstrate the effectiveness of using a second drug-eluting stent as an alternative and successful treatment approach in a CAP patient. This is the case of a 67-year-old female with stable angina pectoris Canadian Cardiovascular Society classification III (CCS III), three-vessel coronary artery disease (CAD), who declined CABG (Syntax score of 44) and had type II diabetes mellitus. The patient underwent elective percutaneous coronary intervention (PCI), and we identified diffuse stenosis in the proximal to distal portions of the left anterior descending artery (LAD) with extensive calcification. Furthermore, there was a chronic total occlusion (CTO) in obtuse marginal (OM) 2, as well as critical stenosis in OM3, 80% stenosis in the proximal part of right coronary artery (RCA), 90% stenosis in the middle of the RCA, 90–95% in the distal RCA, and diffuse stenosis ranging from 70–80% in the distal posterolateral. During the procedure to alleviate the stenosis in the left circumflex artery (LCx), we encountered a coronary perforation classified as Ellis type III while using a 2.5/20 mm NC balloon inflated to 12 atm for 12 seconds. In response, we performed stent placement from the proximal LCx to OM2 using the Xience Xpedition drug-eluting stent (DES) measuring 2.5/28 mm. Subsequently, we conducted extended balloon inflation (intermittent) for five minutes. Despite these efforts, the coronary perforation, still classified as Ellis type III, persisted. We decided to employ intrastent stenting (a second DES strategy) with the Coroflex Isar DES measuring 2.5/28 mm, followed by prolonged balloon inflation. The outcome revealed no remaining perforation, Thrombolysis in Myocardial Infarction (TIMI) III flow, and no complications such as pericardial effusion after 48 hours of monitoring. The implantation of a second DES proved to be a practical approach for managing a significant CAP.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective?

Munirwan,

Hadi,

Purnawarman

et al. 2024

Narra J

View full text Add to dashboard Cite

show abstract

“…[1][2][3] The minimum stent area (MSA) is the strongest predictor of future adverse events, including ISR [4][5][6] ; and severe calcification is the most frequent cause of stent underexpansion. 7,8 Nonetheless, stent underexpansion can occur even in non-severely calcified lesions (i.e., calcification <180°) despite anticipating satisfactory stent expansion before stent implantation [9][10][11][12][13][14][15] (Table S1). To date, there has been no systematic evaluation of lesion characteristics that are associated with stent underexpansion in the absence of severe calcification.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and anatomical factors associated with stent under‐expansion in non‐severely calcified lesions

Sato,

Matsumura,

Yamamoto

et al. 2024

Cathet Cardio Intervent

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BackgroundStent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non‐severely calcified lesions.AimWe sought to identify the prevalence and anatomical characteristics of underexpansion in non‐severely calcified lesions.MethodsWe included 993 patients who underwent optical coherence tomography‐guided PCI of 1051 de novo lesions with maximum calcium arc <180°. Negative remodeling (NR) was the smallest lesion site external elastic lamina diameter that was also smaller than the distal reference. Stent expansion was evaluated using a linear regression model accounting for vessel tapering; underexpansion required both stent expansion <70% and stent area <4.5mm2.ResultsUnderexpansion was observed in 3.6% of non‐heavily calcified lesions (38/1051). Pre‐stent maximum calcium arc and thickness were greater in lesions with versus without underexpansion (median 119° vs. 85°, p = 0.002; median 0.95 mm vs. 0.78 mm, p = 0.008). NR was also more common in lesions with underexpansion (44.7% vs. 24.5%, p = 0.007). In the multivariable logistic regression model, larger and thicker eccentric calcium, mid left anterior descending artery (LAD) location, and NR were associated with underexpansion in non‐severely calcified lesions. The rate of underexpansion was especially high (30.7%) in lesions exhibiting all three morphologies. Two‐year TLF tended to be higher in underexpanded versus non‐underexpanded stents (9.7% vs. 3.7%, unadjusted hazard ratio [95% confidence interval] = 3.02 [0.92, 9.58], p = 0.06).ConclusionAlthough underexpansion in the absence of severe calcium (<180°) is uncommon, mid‐LAD lesions with NR and large and thick eccentric calcium were associated with underexpansion.

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A Case Series of Eight Coronary Artery Perforations and a Review of the Up-to-Date Literature

Cited by 2 publications

References 13 publications

Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective?

Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective?

Prevalence and anatomical factors associated with stent under‐expansion in non‐severely calcified lesions

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