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. 2023 Oct 26;13(11):1542.
doi: 10.3390/jpm13111542.

A Novel Strategy for Emergency Treatment of Coronary Perforations by Placing a Drug-Eluting Stent before Sealing off the Leakage with a Covered Stent to Improve Long-Term Outcomes in Patients with Coronary Artery Perforations

Mohamed Ayoub  1 , Noé Corpataux  2 , Péter Tajti  3 , Michael Behnes  4 , Tobias Schupp  4 , Jan Forner  4   5 , Ibrahim Akin  4 , Dirk Westermann  6 , Volker Rudolph  1 , Kambis Mashayekhi  6   7
Affiliations

A Novel Strategy for Emergency Treatment of Coronary Perforations by Placing a Drug-Eluting Stent before Sealing off the Leakage with a Covered Stent to Improve Long-Term Outcomes in Patients with Coronary Artery Perforations

Mohamed Ayoub et al. J Pers Med. .

Abstract

We aimed to investigate the safety, feasibility, and long-term results of drug-eluting stent implantation before covered stents for treating coronary artery perforation (CAP). Between 2015 and 2020, 12,733 patients undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. The primary endpoint was 1-year target lesion revascularization (TLR), whereas secondary endpoints included the rate of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death at 1 year. A total of 159 patients with CAP were identified during the study period, of whom 47.2% (n = 75) were treated with a covered stent (CS group) because of complex and/or severe CAP and 84 (52.8%) without (non-CS group). In the majority of patients, emergency drug-eluting stent placement before covered stent implantation was feasible (n = 69, 82%). There were no significant differences among patients treated with or without a covered stent in terms of primary or secondary clinical endpoints: a similar rate of TLR (18.67% vs. 21.43%, p = 0.6646), MACCE (25.33% vs. 22.62%, p = 0.6887), and 1-year mortality (12.00% vs. 11.90%, p = 0.9853) were identified comparing cases with covered stent implantation and without. In conclusion, our study implicates that the use of covered stents for sealing coronary perforation might not impact the 1-year clinical outcome if used properly. Moreover, the emergent use of drug-eluting stents before covered stent implantation in CAP is a safe and effective method to avoid target lesion revascularization in patients treated with covered stents.

Keywords: coronary artery disease; covered stent; perforation.

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Conflict of interest statement

Kambis Mashayekhi reports consulting/speaker/proctoring honoraria from Abbott Vascular, Abiomed, Asahi Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi Sankyo, Medtronic, Shockwave Medical, Teleflex, Terumo. Mohamed Ayoub reports consulting/speaker/proctoring honoraria from Asahi Intecc, Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Teleflex, and Terumo. Noé Corpataux acknowledges funding from the European Society of Cardiology through an ESC Training Grant and a Gottfried & Julia Bangerter-Rhyner Foundation Grant. These Grants support his fellowship in Germany. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the patients with a therapy strategy.
Figure 2
Figure 2
In-hospital clinical outcomes were stratified by whether a covered stent was used or not.
Figure 3
Figure 3
1-year clinical outcomes stratified by whether covered stent was used or not.
See this image and copyright information in PMC

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