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Coronary artery perforation is a rare complication of percutaneous coronary intervention (PCI) and the incidence was reported around 0.4%. Few studies focused on the clinical outcome after covered stent implantation for coronary perforation. The aim of this study was to evaluate the clinical outcomes of the PTFE-covered stent for coronary artery perforation and compare the results between patients with and without cardiac tamponade.
During April 2004 and February 2016, a total 48 patients underwent implantation using poly tetrafluoroethylene-covered JOSTENT Graft Master stents (Abbott Vascular, Santa Clara, California) in the native coronary arteries implantation for coronary artery perforation. Clinical outcomes such as target lesion revascularization (TLR), myocardial infarction (MI), definite or possible stent thrombosis, cardiovascular mortality, and all-cause mortality were analyzed.
The average age of study patients was 68.02 ± 13.49 years, and a majority of the subjects were men (76.6%). The most frequent devices cause of perforation were stents (37.5%). 18 patients (37.5%) experienced cardiac tamponade and 20 patients (41.7%) underwent emergent pericardiocentesis. Only 1 patient (2.1%) experienced emergent surgical repair after covered stent. At the 30-day follow-up, the rate of all-cause mortality was 16.7% and cardiovascular mortality was 13.0%. At the one-year follow-up, the rate of myocardial infarction was 6.1%, the rate of TLR was 21.9%, the rate of definite or possible stent thrombosis was 15.6%, the rate of cardiovascular mortality was 22.0%, and the rate of all-cause mortality was 26.2%. Between the patients with and without cardiac tamponade, patients with cardiac tamponade had higher cardiovascular mortality in 30-day and also higher all-cause mortality in 30-day and one-year follow-up.
The covered stent could solve emergent condition for patients with coronary artery perforation with high TLR and stent thrombosis rate at long-term follow-up. The patients with cardiac tamponade had worse clinical outcomes in 30-day and one-year follow-up.