Outcomes after use of covered stents to treat coronary artery perforations. Comparison of old and new‐generation covered stents

Abstract

Time to deliver was shorter with the PL-CS and resulted in lower rate of pericardial effusion and cardiac arrest. However, there were no significant differences in procedural success and 1-year follow-up MACE in patients treated with PL-CS or PTFE-CS.

PCI on a tear: Not all perforations need coverage

“…Unfortunately, the lower profile covered stents have not translated into greater procedural success; there was no difference in deliverability between the Graftmaster Rx (Abbott Vascular) and Aneugraft Dx (ITGI Medical, Santa Clara, CA) in this study. These results are in line with another study that retrospectively compared the Jostent Graftmaster (Abbott Vascular) PTFE covered stent with PK Papyrus stent (BIOTRONIK) in the treatment of CAP and found that while the newer PK Papyrus stent had shorter time to delivery and resulted in a lower rate of pericardial effusion and cardiac arrest, there was no difference in procedural success and 1‐year follow‐up MACE …”

PK Papyrus covered stent: Device description and early experience for the treatment of coronary artery perforations

“…Given the need for both immediate and sustained sealing of the perforation to prevent hemodynamic collapse, covered stents represent the most common method to treat the site of hemorrhage when initial conservative measures (e.g., prolonged balloon inflation) fail. Although perforation management with stents using pericardial or venous covering has been described, the most commonly used covered stent consists of a single polytetrafluoroethylene (PTFE) layering between two coaxial 316L stainless steel, slotted‐tube balloon expandable stents (Graftmaster, Abbott Vascular, Santa Clara, CA; References ). However, the larger crossing profile (1.63–1.73 mm) limits guide catheter compatibility, and the two‐stent layer design challenges deliverability through tortuous and calcified anatomy.…”

“…To date, only one previous series of patients treated with the PK Papyrus stent has been reported. In a retrospective, observational study of 61 patients treated for coronary perforation over a 5 year period, 22 patients received the PK Papyrus stent, and 39 patients were treated with PTFE‐covered stents . Procedural success was numerically, but not significantly higher with the PK Papyrus stent (86% versus 69%, p = .22).…”

“…Covered stents provide a physical barrier to seal perforated or ruptured large vessel coronary arteries and reduce the risk of hemorrhage without the need for invasive surgery, whereas very distal vessel perforations are often treated using embolization techniques. As such, covered stents represent the primary treatment method in emergency situations when initial approaches (e.g., prolonged balloon inflation) are unsuccessful . Prior studies suggest that the use of covered stents improves event‐free survival, enabling a life‐threatening situation to be managed without emergency surgery and with significantly reduced rates of mortality, cardiac tamponade, and major adverse cardiac events …”

Covered stents: A 25‐year odyssey

“…One study retrospectively compared the Jostent Graftmaster (Abbott Vascular, Santa Clara, CA) PTFE covered stent with PK Papyrus stent (BIOTRONIK, Berlin, Germany) in the treatment of coronary artery perforation and found that the newer PK Papyrus stent had shorter time to delivery and resulted in a lower rate of pericardial effusion and cardiac arrest. However, there was no difference in procedural success and 1‐year follow‐up MACE …”