Coronary perforation and covered stents: An update and review

Al-Mukhaini, Mohammed; Panduranga, Prashanth; Sulaiman, Kadhim; Riyami, Abdulla; Deeb, Mohammed; Riyami, Mohamed Barkat

doi:10.4103/1995-705x.86017

Cited by 60 publications

(29 citation statements)

References 22 publications

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“…Thus, covered stent grafts must be analyzed in terms of their sealing capacity in regard to vessel perforation, as well as in terms of their performance concerning endothelization rates, inflammatory reactions, thrombosis, and restenosis formation after implantation. Long-term patency rates are deemed poor, particularly for conventional PTFE-covered stents [ 6 , 7 ]. This further emphasizes the imperative need for new developments and appropriate testing models.…”

Section: Discussionmentioning

confidence: 99%

“…Covered stents are usually made of bare metal stents with a polytetrafluoroethylene (PTFE) or polyurethane coating. These stents display a 90% success rate for the treatment of perforation [ 2 , 6 ]. Their limitations, especially in case of bulky PTFE-covered stents, include significantly higher rates of thrombus formation and restenosis, compared to regular stents [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A preclinical animal model for evaluating the sealing capacity of covered stent grafts in acute vessel perforation

et al. 2020

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Background Percutaneous coronary intervention is among the most common therapeutic interventions in cardiology. This procedure may, however, be associated with a rare, though life-threatening complication: acute coronary perforation (CP). CP is primarily treated using covered stents, which are made of bare metal stents with a polytetrafluoroethylene (PTFE) or polyurethane coating. These stents’ major limitations include higher rates of thrombus formation and restenosis. Hence, there is a still unmet need for new stents regarding their design and composition. Or, to test new covered stent designs, the rabbit iliac artery has become the best-established animal model. This study sought to present a preclinical animal approach designed to test covered stents that are utilized following vessel perforation. Methods The animal experiments were performed using New Zealand white rabbits, each weighting 3.5–4.5 kg. The animal models described herein relied on the three most common clinical causes for CP, such as guidewire-induced, balloon catheter bursting, and device oversizing. Moreover, the sealing capacity of covered stent grafts was assessed for each of these models by means of angiography. Results We herein report a rabbit iliac artery perforation model using three different types of vessel perforation that closely mimic the clinical setting, such as guidewire-induced, balloon catheter rupture, and device oversizing. Using the same rabbit iliac perforation model, we additionally assessed the sealing capacity of a covered stent graft for each model. Conclusions The novel rabbit iliac artery perforation models, as described in this report, represent promising animal testing approaches. While their setting is very similar to the real-life context encountered in humans, all three models are based on an animal model that is ideally suited for evaluating the sealing capacity and performance of new medical devices for humans.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A preclinical animal model for evaluating the sealing capacity of covered stent grafts in acute vessel perforation

et al. 2020

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“…Perhaps the greatest risk for PCI-related dissections is the presence of heavily calcified vessels or chronic total occlusions (CTO) [ 13 , 22 ], which require more aggressive catheter manipulation for better support, and the usage of stiff wires in vessels whose walls are less resistant to trauma [ 1 , 2 , 8 , 11 , 14 – 16 ]. Hydrophilic coated guide wires are associated with increased risk of coronary perforation [ 7 , 21 , 26 , 29 ], due to low coefficient of friction and ease of distal migration [ 29 ]. Amplatz catheters are more frequently associated with ostial coronary artery dissections [ 2 , 7 , 15 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Increased incidence of restenosis and target lesion intervention is also reported [ 7 , 33 , 34 ]. These have been attributed to increased thrombogenicity and delayed endothelialisation of these stents [ 23 , 26 ], thus warranting an extended duration of DAPT of at least 6 months to 1 year [ 24 , 26 , 34 , 35 ]. Prasugrel or ticagrelor are suitable antiplatelet agents of choice, due mainly to their lack of intrinsic resistance [ 23 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Limited aorto-coronary dissections have been successfully managed by stent implantation with good coverage to the ostium of the perforated/dissected vessel [ 1 – 3 , 5 – 7 , 15 , 16 , 19 , 22 ]. In the modern era, polytetrafluoroethylene (PTFE) covered stents have emerged as a revolutionary strategy to seal the entry site, particularly in cases of perforation [ 6 , 7 , 10 , 23 – 26 ]. They are also associated with better long term outcome and prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report

et al. 2017

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BackgroundRight coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention.Case presentationA 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection.ConclusionsThe polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2867-3) contains supplementary material, which is available to authorized users.

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