Treatment of Coronary Artery Perforations Complicating Percutaneous Coronary Intervention With a Polytetrafluoroethylene-Covered Stent Graft

Lansky, Alexandra J.; Yang, Yufei; Khan, Yosef; Costa, Ricardo; Pietras, Cody; Tsuchiya, Y.; Cristea, Ecaterina; Collins, Michael B.; Mehran, Roxana; Dangas, George; Moses, Jeffrey W.; Leon, Martin B.; Stone, Gregg W.

doi:10.1016/j.amjcard.2006.02.041

Cited by 105 publications

(84 citation statements)

References 12 publications

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“…A covered stent can then be introduced on a second wire via this new guiding catheter. Deflation and retraction of the original balloon permits advancement of the second guidewire and the covered stent for definitive closure of the perforation, limiting the period of coronary extravasation to only a few seconds [39]. Covered stents (stent grafts) are layered with a relatively nonporous fabric-like material on one or both sides of the stent.…”

Section: Devices and Materials For Perforationmentioning

confidence: 99%

“…Modern percutaneous options for the treatment of coronary perforation include prolonged inflation of a standard or perfusion balloon, use of stents, covered stents [33,[37][38][39][40], and either coils or microparticles for embolization [41][42][43] in distal vessel rupture. Other techniques reported include the use of thrombin injection, [44,45] fibrin glue, [46] and gelfoam embolization [47].…”

Section: Coronary Perforation And/or Rupturementioning

confidence: 99%

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Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Godino

Sharp

Carlino

et al. 2009

Cathet Cardio Intervent

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Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains one of the major challenges in interventional cardiology. The appropriate use of the rapidly increasing range of tools available to interventional cardiologists is bringing more and more CTOs into the 'treatable' category. The bar has now been raised to 80% success rates by some expert operators around the world, which, in our view, cannot be achieved without a thorough understanding of technique and technical know-how. CTO procedures are increasingly becoming a sub-specialist field within interventional cardiology and we would encourage centers to consider appointing 'super-specialists' who are able to concentrate experience and expertise in this area. In this paper we detail the principal characteristics of the over the wire balloons, microcatheters and guidewires at present available, the most popular and recent of which are listed in Table 1 and 2. The knowledge and the specific choice of these materials and the criteria for selection of your guidewire or microcatheter can mean the difference between success and failure. Moreover, we discuss on the most important and groundbreaking techniques to approach a CTO. Finally, considering the greater risk of coronary perforation related to a CTO procedure compared to routine PCI, we describe which are best strategy and devices for treating coronary perforations and other major complications.

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Section: Devices and Materials For Perforationmentioning

confidence: 99%

Section: Coronary Perforation And/or Rupturementioning

confidence: 99%

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Godino

Sharp

Carlino

et al. 2009

Cathet Cardio Intervent

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show abstract

“…In grade III perforations, sudden onset tachycardia, chest pain, agitation, hypotension, increased jugular venous pressure, rapid development of tamponade may occur. In these patients, promptly inserted PTFEcovered stent prevents the development of sudden tamponade and cardiogenic shock [10,14]. Ellis et al reported an incidence of tamponade of 63% and a mortality rate of 19% in coronary artery perforations [3].…”

Section: Discussionmentioning

confidence: 99%

Fatal complication, rescue therapy; covered stent for coronary artery perforation

Yıldız¹,

Karakurt²,

Bitigen³

et al. 2013

Health

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Introduction: Although coronary perforation is a rare complication observed during intervenetional procedures, it has a considerably high mortality rate. The prevelance of coronary perforation has been reported to be 0.20% -0.6%. Its sudden development, the patient's agitation and development of rapid collapse render intervention difficult. Materials and Method: The presence of perfusion balloon and covered stent in clinics is life-saving. In the present study, we retrospectively reviewed 17 cases with coronary artery perforation that were treated between 2009 and 2012. Of these patients, 10 (58.8%) were men and 7 (41.2%) were women; the median age was 62.8 ± 8.3 years. The coronary artery perforation resulted from guide wire in 23.5%, balloon dilatation in 58.8% and stent implantation in 17.6%. All the lesions were either type B or C lesions. Results: The extensiveness of perforation was Ellis grade I in 23.5%, grade II in 47.1% and grade III in 29.4% of the cases. In the treatment of the perforation, polytetrafluoroethylene-covered stent graft was implemented in 9 (52.9%) patients, whilst conventional and emergency surgical therapy was performed in 8 (47.1%) patients. Grade I perforations occurred due to the guide wire and were managed with conventional therapy (p < 0.05). Grade II and III perforations resulted from balloon and stent. The majority of these patients were inserted Graft Stent (stent graft in 52.9% and conventional therapy in 23.5% of the cases (p < 0.05). Although all the stent grafts were successfully implanted, the complete control of bleeding was achieved only in 77.7% of the patients. Mortality was not observed in grade I perforation, whilst all cases resulted in mortality had grade III perforation. Conclusion: These data indicate that there is a need for further advanced technology in the coronary artery perforation despite of currently available therapeutic options.

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“…The traditional and commonly used method of perforation treatment consists of implantation of a polytetrafluoroethylene-covered stent graft [10]. The use of stent grafts may be considered for "cavity spilling" perforations only in cases where a guidewire is definitely placed in the true arterial lumen and the origin of the fistula is perpendicular to the arterial lumen.…”

Section: Prawa Tętnica Wieńcowa (Projekcja Lao 17° Cra 19°) -Masywmentioning

confidence: 99%

“Cavity spilling” perforation during recanalisation of the right coronary artery – reocclusion of the recanalised artery as a method of emergency treatment

Kurianowicz¹,

Zapolski²,

Wróbel³

et al. 2012

pwki

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A b s t r a c tCoronary artery perforation is an uncommon but potentially life-threatening complication of percutaneous coronary interventions. We report a case of a 78-year-old patient with "cavity spilling" right coronary artery perforation leading to formation of a fistula with contrast spilling directly to the right ventricle which occurred during recanalisation of the chronically occluded coronary artery. This rare complication was treated with a polytetrafluoroethylene-covered stent graft implanted into the right ventricular artery at the site of the right ventricular branch, followed by reocclusion of the right coronary artery and complete patient recovery. A control coronary angiography after 6 months has been scheduled.Key words: perforation, coronary artery fistula, cavity spilling, stent graft S t r e s z c z e n i e Perforacja tętnicy wieńcowej jest rzadkim powikłaniem przezskórnych interwencji wieńcowych, stanowiącym potencjalne zagrożenie życia. Przedstawiono przypadek perforacji typu cavity spilling prawej tętnicy wieńcowej w czasie rekanalizacji długotrwale zamkniętej tętnicy u 78-letniej chorej z wytworzeniem przetoki do prawej komory serca. To niezwykle rzadkie powikłanie opanowano poprzez implantację do początkowego odcinka prawej tętnicy wieńcowej i jej gałęzi prawokomorowej stentgraftu pokrytego politetrafluoroetylenem, co spowodowało ponowne zamknięcie rekanalizowanej tętnicy, ale pozwoliło na pełną stabilizację stanu chorej. Zaplanowano wykonanie kontrolnej koronarografii za 6 miesięcy.

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Treatment of Coronary Artery Perforations Complicating Percutaneous Coronary Intervention With a Polytetrafluoroethylene-Covered Stent Graft

Cited by 105 publications

References 12 publications

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Crossing CTOs—The tips, tricks, and specialist Kit that can mean the difference between success and failure

Fatal complication, rescue therapy; covered stent for coronary artery perforation

“Cavity spilling” perforation during recanalisation of the right coronary artery – reocclusion of the recanalised artery as a method of emergency treatment

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