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
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Definitions
2.3. Statistical Methods
3. Results
Procedural Outcomes at 1 Year of Follow-Up
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall (n = 159) | Covered Stents (n = 75) | No Covered Stents (n = 84) | p Value | |
---|---|---|---|---|
Age (years) | 72.8 ± 9.7 | 74.3 ± 8.7 | 71.4 ± 10.4 | 0.0581 |
Men | 70.44% (112) | 66.67% (50) | 73.81% (62) | 0.3245 |
BMI (kg/m2) | 26.4 ± 3.6 | 26.3 ± 3.8 | 26.5 ± 3.5 | 0.7756 |
eGFR | 64.7 ± 20.3 | 62.7 ± 20.5 | 66.5 ± 20.1 | 0.2623 |
Class angina (CCS > II) | 60.58% (83) | 65.67% (44) | 55.71% (39) | 0.2332 |
CAD presentation | 0.7197 | |||
| 20.13% (32) | 21.33% | 19.05% | |
| 79.87% (127) | 78.66% | 80.95% | |
Diabetes mellitus | 30.20% (45) | 22.54% (16) | 37.18% (29) | 0.0518 |
Dyslipidemia | 88.36% (129) | 83.10% (59) | 93.33% (70) | 0.0540 |
Hypertension | 90.26% (139) | 97.33% (73) | 83.54% (66) | 0.0039 |
Smoking (current) | 12% (18) | 12.33% (9) | 11.69% (9) | 0.9040 |
LVEF (%) | 0.9555 | |||
| 56.86% (87) | 56.00% (42) | 57.69% (45) | |
| 28.76% (44) | 30.66% (23) | 26.92% (21) | |
| 8.50% (13) | 8.00% (6) | 8.97% (7) | |
| 5.88% (9) | 5.33% (4) | 6.41% (5) | |
History of familiar CAD | 31.78% (41) | 30.65% (19) | 32.84% (22) | 0.7895 |
Prior MI | 30.56% (44) | 37.68% (26) | 24.00% (18) | 0.0750 |
Prior CABG | 20.00% (29) | 26.09% (18) | 14.47% (11) | 0.0808 |
LDL max. | 100.1 ± 39.0 | 97.5 ± 35.6 | 102.5 ± 41.8 | 0.419 |
Overall (n = 159) | Covered Stents (n = 75) | No Covered Stents (n = 84) | p Value | |
---|---|---|---|---|
Target coronary vessel | <0.0001 | |||
| 5.66% (9) | 4.00% (3) | 7.14% (6) | |
| 47.17% (75) | 56.00% (42) | 39.29% (33) | |
| 11.32% (18) | 8.00% (6) | 14.29% (12) | |
| 35.22% (56) | 30.67% (23) | 39.29% (33) | |
| 0.63% (1) | 1.33% (1) | 0.00% (0) | |
Number of treated vessels | 1.4 ± 0.7 | 1.4 ± 0.65 | 1.5 ± 0.7 | 0.3076 |
Lesion length (mm) | 0.3149 | |||
| 10.60% (16) | 8.45% (6) | 12.50% (10) | |
| 32.45% (49) | 28.17% (20) | 36.25% (29) | |
| 56.95% (86) | 63.38% (45) | 51.25% (41) | |
Pre-PCI stenosis, % | 87.1 ± 17.9 | 87.1 ± 18.6 | 87.1 ± 17.2 | 0.9936 |
AHA/ACC classification | 0.0040 * | |||
| 12.58% (20) | 4.00% (3) | 20.24% (17) | |
| 20.13% (32) | 22.66% (17) | 17.86% (15) | |
| 67.30% (107) | 73.33% (55) | 61.90% (52) | |
Ostial lesion | 3.8% (6) | 4.00% (3) | 3.57% (3) | 1.0000 |
Calcification | 0.0084 | |||
| 5.06% (8) | 2.67% (2) | 7.23% (6) | |
| 21.52% (34) | 12.00% (9) | 30.12% (25) | |
| 22.78% (36) | 22.67% (17) | 22.89% (17) | |
| 50.63% (80) | 62.67% (47) | 39.76% (33) | |
Excentric calcification | 66.67% (98) | 64.29% (45) | 68.83% (53) | 0.5593 |
Severe tortuosity | 17.83% (28) | 17.33% (13) | 18.29% (15) | 0.8754 |
Relevant side branch | 29.03% (45) | 27.03% (20) | 30.86% (25) | 0.5991 |
Intra-lesion Angulation | 0.6127 | |||
| 17.72% (28) | 21.33% (16) | 14.46% (12) | |
| 40.51% (64) | 36.00% (27) | 44.58% (37) | |
| 32.91% (52) | 33.33% (25) | 32.53% (27) | |
| 8.86% (14) | 9.33% (7) | 8.43% (7) |
Total (n = 159) | Covered Stents (n = 75) | No Covered Stents (n = 84) | p Value | |
---|---|---|---|---|
Technical success | 89.94% (143) | 93.33% (70) | 86.90% (73) | 0.1786 |
Procedural success | 83.65% (133) | 85.33% (64) | 82.14% (69) | 0.5871 |
Balloon diameter predilatation (mm) | 2.8 ± 1.3 | 3.1 ± 1.8 | 2.5 ± 0.6 | 0.0037 * |
Maximum predilation pressure (atm) | 17.5 ± 6.1 | 18.7 ± 7.6 | 16.5 ± 4.9 | 0.1037 |
Number of stents implanted | 1.6 ± 1.1 | 1.7 ± 1.2 | 1.5 ± 1.2 | 0.2546 |
Diameter of implanted stent (mm) | 3.2 ± 0.6 | 3.31 ± 0.6 | 3.1 ± 0.5 | 0.2376 |
DES implanted before covered stent | 69.0% | 92% | - | 1.0000 |
Diameter of covered stents | 3.4 ± 0.7 | 3.4 ± 0.7 | - | 1.0000 |
Length of covered stents | 23.3 ± 14.2 | 23.34 ± 14.2 | - | 1.0000 |
Balloon diameter postdilatation (mm) | 3.9 ± 0.8 | 4.3 ± 0.5 | 3.4 ± 0.5 | 0.3966 |
Postdilatation pressure (atm) | 19.5 ± 5.1 | 20.1 ± 6.5 | 19.0 ± 3.3 | 0.7127 |
Rotational atherectomy | 18.87% (30) | 26.66% (20) | 11.90% (10) | 0.0176 |
TIMI flow post PCI | 0.1287 | |||
| 11.04% (17) | 6.94% (5) | 14.63% (12) | |
| 88.96% (137) | 93.06% (67) | 85.37% (70) | |
Access site | 0.4636 | |||
| 38.89% (56) | 43.28% (29) | 35.06% (27) | |
| 61.11% (88) | 56.72% (38) | 64.94% (50) | |
Guiding catheter size, Fr | 0.1890 | |||
| 60.53% (92) | 48.57% (34) | 70.73% (58) | |
| 34.21% (52) | 44.29% (31) | 25.61% (21) | |
| 5.26% (8) | 7.14% (5) | 3.66% (3) | |
CTO target vessel | 44.30% (70) | 52.0% (39) | 37.35% (31) | 0.0641 |
CTO technique used | 0.5319 | |||
| 57.14% (40) | 53.85% (21) | 61.29% (19) | |
| 42.86% (30) | 46.15% (18) | 38.71% (12) | |
Procedural time (min) | 101 (71, 163) | 120 (85, 198) | 86 (56.3, 135) | 0.0002 |
Fluoroscopy time (min) | 35 (21, 71) | 47.5 (28.6, 98.8) | 27.0 (18.5, 53.5) | 0.0006 |
Fluoroscopic Dose Area Product (cGy*cm2) | 10,537 (5720, 17,898) | 13,968 (7666, 22,075) | 8210 (4779, 15,553) | 0.0034 |
Contrast volume used (mL) | 300 (190, 400) | 325 (200, 407.5) | 260 (177.5, 380) | 0.0803 |
Ellis classification | 0.0001 | |||
| 7.75% (16) | 4.48% (3) | 10.67% (8) | |
| 34.51% (49) | 38.81% (26) | 30.67% (23) | |
| 33.10% (47) | 55.22% (37) | 13.33% (10) | |
| 24.65% (35) | 1.49% (1) | 45.33% (34) |
Overall (n = 159) | Covered Stents (n = 75) | No Covered Stents (n = 84) | p Value | |
---|---|---|---|---|
Not clear | 30.82% (49) | 8.00% (6) | 51.19% (43) | <0.0001 * |
Wire or microcatheter exit | 23.27% (37) | 14.67% (11) | 30.95% (43) | |
Severe calcification | 23.90% (38) | 44.00% (33) | 5.95% (26) | |
Subintimal stenting | 1.9% (3) | 4.00% (3) | 0.00% (0) | |
Oversized balloon or stent | 10.7% (17) | 17.33% (13) | 4.76% (4) | |
Collateral perforation | 3.14% (5) | 1.33% (1) | 4.76% (4) | |
Tortuosity with calcification | 6.3% (10) | 10.67% (8) | 2.38% (2) |
Overall (n = 159) | Covered Stents (n = 75) | No Covered Stents (n = 84) | p Value | |
---|---|---|---|---|
In-hospital MACCE | 8.18% (13) | 9.33% (7) | 7.14% (6) | 0.6148 |
1-year Mortality | 11.95% (19) | 12.00% (9) | 11.90% (10) | 0.9853 |
1-year MI | 2.52% (4) | 1.33% (1) | 3.57% (3) | 0.6227 |
1-year TLR | 20.13% (32) | 18.67% (14) | 21.43% (18) | 0.6646 |
1-year stroke | 1.26% (2) | 2.67% (2) | 0.00% (0) | 0.2209 |
1-year MACCE | 23.90% (38) | 25.33% (19) | 22.62% (19) | 0.6887 |
Pericardiocentesis | 22.58% (35) | 29.33% (22) | 16.25% (13) | 0.0516 |
Myocardial hematoma | 1.96% (3) | 2.74% (2) | 1.25% (1) | 0.6059 |
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Ayoub, M.; Corpataux, N.; Tajti, P.; Behnes, M.; Schupp, T.; Forner, J.; Akin, I.; Westermann, D.; Rudolph, V.; Mashayekhi, K. 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. J. Pers. Med. 2023, 13, 1542. https://doi.org/10.3390/jpm13111542
Ayoub M, Corpataux N, Tajti P, Behnes M, Schupp T, Forner J, Akin I, Westermann D, Rudolph V, Mashayekhi K. 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. Journal of Personalized Medicine. 2023; 13(11):1542. https://doi.org/10.3390/jpm13111542
Chicago/Turabian StyleAyoub, Mohamed, Noé Corpataux, Péter Tajti, Michael Behnes, Tobias Schupp, Jan Forner, Ibrahim Akin, Dirk Westermann, Volker Rudolph, and Kambis Mashayekhi. 2023. "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" Journal of Personalized Medicine 13, no. 11: 1542. https://doi.org/10.3390/jpm13111542