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Jurado-Román A, Tébar-Márquez D, Hernandez-Enríquez M, Birkemeyer R, Rodríguez-Leor O, Spinu R, Belle L, Galeote G, Jiménez-Valero S, Moreno R. Meta-long Papyrus: Meta-analysis of mid to long-term outcomes of PK Papyrus covered stent. Catheter Cardiovasc Interv 2024. [PMID: 39033331 DOI: 10.1002/ccd.31157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/26/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Although covered stents (CS) represent a potentially life-saving intervention for coronary perforation (CAP), their application has expanded to other contexts, including coronary aneurysms (CAA). However, data regarding mid- and long-term outcomes of CS in these settings scenarios remains limited. AIMS This meta-analysis aims to evaluate major adverse cardiac events (MACE) from discharge through long-term follow-up in patients undergoing percutaneous coronary intervention with the new generation polyurethane-covered cobalt-chromium PK Papyrus CS. METHODS We conducted a meta-analysis of data from three observational trials that included long-term follow-up of patients who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus, and PAST-PERF registry. RESULTS 332 patients underwent PK Papyrus CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for other indications. After a mean follow-up of 16.2 months, the MACE was 14.3%, with Target Lesion Revascularization (TLR) being the most frequent (8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD), 2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015). CONCLUSIONS The clinical outcomes following PK Papyrus CS implantation are deemed acceptable, considering the challenging scenarios and the existing alternative treatments. However, MACE rates in patients with CAA who received Papyrus PK CS were significantly higher than in those with CAP, underscoring the importance of meticulous patient selection and optimization of CS in these complex patients and coronary anatomies.
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Affiliation(s)
- Alfonso Jurado-Román
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Daniel Tébar-Márquez
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | | | | | | | - Radu Spinu
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Loïc Belle
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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Adams RC, Hegde S, Sutphin P, Iqbal S, Irani Z, Kalva SP. Use of Polyurethane-Covered Stents for Exclusion of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2024; 47:360-365. [PMID: 38180506 DOI: 10.1007/s00270-023-03638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To evaluate the safety, technical success and short-term effectiveness of polyurethane-covered stent (PK Papyrus, BioTronik, Berlin) in the treatment of pulmonary arteriovenous malformations (PAVMs) that are not amenable to embolotherapy. MATERIALS AND METHODS In this IRB-approved, retrospective study, data from patients who received polyurethane-covered stents for exclusion of PAVMs were analyzed. The study included 5 patients (all women) with a median age of 40 years (range 25-60). Patients presented with hypoxemia, TIAs, and/or epistaxis; 4 were confirmed to have HHT. All had multiple PAVMs diagnosed on chest CT and underwent embolization with other devices in addition to the polyurethane-covered stent. The indication for stent placement in all cases was a short and/or tortuous feeding artery. Safety was assessed by immediate or short-term complications, e.g., migration, stent thrombosis, and fracture. Technical success was defined as the ability to accurately place the stent at the intended location. Effectiveness was defined as successful exclusion of PAVM with no perfusion across the AVM. RESULTS Technical success of stent placement was 100%. AVM exclusion rate was 80% after single stent deployment; in the case of incomplete exclusion, success was achieved using an overlapping stent to completely cover a second feeding artery. During the median follow-up period of 5 months (range 2-10), all stents remained patent, and AVMs were excluded without other complications. CONCLUSION Exclusion of PAVMs with polyurethane-covered stents is technically feasible, safe, and shows short-term effectiveness for PAVMs with a short/tortuous feeding artery when traditional embolization techniques are not possible.
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Affiliation(s)
- Ryan C Adams
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA.
| | - Siddhi Hegde
- Abdominal Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Sutphin
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Shams Iqbal
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Zubin Irani
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
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Rao SV, Kandzari DE. Lifting the Regulatory Blanket Off of Covered Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:37-38. [PMID: 37029040 DOI: 10.1016/j.carrev.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Sunil V Rao
- New York University Langone Health System, New York, NY, USA.
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Kandzari DE, Sarao RC, Waksman R. Clinical experience of the PK Papyrus covered stent in patients with coronary artery perforations: Results from a multi-center humanitarian device exemption survey. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:97-101. [DOI: 10.1016/j.carrev.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
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Di Mario C, Ciardetti N, Demola P. Second Generation: Better Also for Covered Stents? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:29-31. [PMID: 34420692 DOI: 10.1016/j.carrev.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy.
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
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Jurado-Roman A, Gonzalvez A, Jimenez-Valero S, Galeote G, Moreno R, de Sa EL. What have we learnt from the use of papyrus covered stent in France and Spain? Catheter Cardiovasc Interv 2021; 98:410. [PMID: 33484045 DOI: 10.1002/ccd.29469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ariana Gonzalvez
- Department of Cardiology, La Paz University Hospital, Madrid, Spain
| | | | | | - Raul Moreno
- Department of Cardiology, La Paz University Hospital, Madrid, Spain
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Hernández-Enríquez M, Boudou N, Belle L. Reply to "what have we learnt from the use of Papyrus covered stent in France and Spain?". Catheter Cardiovasc Interv 2021; 98:411-412. [PMID: 33484048 DOI: 10.1002/ccd.29462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Marco Hernández-Enríquez
- Cardiology Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Nicolas Boudou
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Loic Belle
- Cardiology Department, Hospital of Annecy, Annecy, France
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Wańha W, Januszek R, Kołodziejczak M, Kuźma Ł, Tajstra M, Figatowski T, Smolarek-Nicpoń M, Gruz-Kwapisz M, Tomasiewicz B, Bartuś J, Łoś A, Jagielak D, Roleder T, Włodarczak A, Kulczycki J, Kowalewski M, Hudziak D, Stachowiak P, Gorący J, Sierakowska K, Reczuch K, Jaguszewski M, Dobrzycki S, Smolka G, Bartuś S, Ochała A, Gąsior M, Wojakowski W. Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry. PLoS One 2021; 16:e0249698. [PMID: 33979357 PMCID: PMC8115813 DOI: 10.1371/journal.pone.0249698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. METHODS This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). RESULTS The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. CONCLUSIONS The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michalina Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Tajstra
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Figatowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Malwina Smolarek-Nicpoń
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Monika Gruz-Kwapisz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Łoś
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | | | - Jan Kulczycki
- Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Paweł Stachowiak
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Jarosław Gorący
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | | | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Mueed A, Khatti S, Ashraf J, Aarij KM, Waqas M, Khan TM. Arrhythmia in Acute Myocardial Infarction: A Six-Month Retrospective Analysis From the National Institute of Cardiovascular Diseases. Cureus 2020; 12:e11322. [PMID: 33304665 PMCID: PMC7720432 DOI: 10.7759/cureus.11322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a devastating medical emergency that requires immediate pharmacological and radiological intervention. With the advent of techniques such as percutaneous coronary intervention (PCI), pacemakers, and percussion pacing, survival rates have improved significantly. However, there are certain factors and complications associated with AMI that still lead to a high mortality rate, such as old age, advanced heart disease, diabetes mellitus (DM), and arrhythmias. Factors such as the type of arrhythmia, the heart rate, and the level at which dissociation occurs between atrial and ventricular rhythm all influence mortality and morbidity rates. Outcomes are further influenced by the sex of the patient, the type of AMI [ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)], history of smoking, arrival times at the hospital, presence of hyperglycemia, previous history of cardiac surgery, and the need for a temporary pacemaker or a permanent pacemaker. As with most scientific studies, local data from Pakistan is hard to find on this topic as well. With this study, we hope to contribute valuable information and updates to the study of a developing problem from the developing world. Objective We aimed to analyze the frequency and outcomes of different types of arrhythmia in AMI. Methods This study involved a retrospective observational cohort. It was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2019 to July 2019 (six months). All data were retrieved from the online database at the NICVD. Written consent was obtained from all patients. Patient confidentiality was ensured at all times. Results A total of 500 patients were included in the study. The mean age of our cohort was 56.17 ±14.01 years. NSTEMI was more prevalent than STEMI. Sinus arrhythmia (SA) was the most frequently recorded arrhythmia and had the best survival rates. Atrioventricular (AV) nodal blocks and ventricular tachycardia (VT) had the worst outcomes. The overall mortality rate was 11.4%, and the mean in-hospital length of stay was 2.07 ±1.54 days. Smoking increased mortality in all cases. Conclusions AMI is complicated by several types of arrhythmia. SA is the most common arrhythmia in AMI. Mortality in AMI is largely due to AV nodal blocks and VT. Smoking increases mortality in all cases.
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Affiliation(s)
- Abdul Mueed
- Cardiac Electrocardiography, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Shahzad Khatti
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jibran Ashraf
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Khawaja M Aarij
- Noninvasive Imaging, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Waqas
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tariq M Khan
- Cardiac Surgery, College of Physicians and Surgeons Pakistan, Karachi, PAK
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