Combined membrane covered and uncovered stents for coronary arteriovenous fistula associated with atherosclerotic plaque in a patient with acute myocardial infarction

Acute and long-term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3-CAP registry

BACKGROUND

Covered stent (CS) implantation is considered a useful device in the setting of Grade III Coronary Perforation (G3CP), one of the most harmful PCI complication. However, data regarding efficacy of this device and clinical outcomes are still limited.

METHODS AND RESULTS

From 1993 to 2015, among 97,779 patients from 9 European centres undergoing PCI, 224 patients had G3CP (0.23%), and 102 patients were managed with CS implantation (96 with PTFE, 6 with pericardium). Device oriented composite endpoint (DOCE), a composite of cardiac death, target lesion revascularization, and stent thrombosis (ST) in-hospital and at long term follow-up were evaluated. G3-CP perforations were successfully sealed with CS in 88 patients (86.3%) with need of intraprocedural pericardiocentesis in one-third of cases. Protamine as heparin reversal agent was administered in 36 (35%) of cases. The cumulative incidence of in-hospital DOCE were 16.6% (17/102): death 14.7%, TLR 2.9%, ST 3.9%. At long-term follow-up (mean 42 ± 38 months), DOCE rates occurred in 19.7%: death 7.4%, TLR 11%, and ST 6.2%. Indication to Dual Antiplatelet Therapy (DAPT) was lifelong in 20% of cases, 1 to 6 months in 22.5% and 12-months in 57.5% without differences in long-term DOCE before and after DAPT interruption (8.0 vs. 6.6%, respectively, P = 0.20).

CONCLUSIONS

Use of CS was successful in sealing grade 3 coronary artery perforations in the majority of cases. Beside the high rate of clinical events at short and long-term, ST remains the leading cause of device failure.

Coronary covered stents

Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.

Recurrent coronary arteriovenous fistula associated with in-stent restenosis of graft stent

Recent studies showed that graft stenting for treating the coronary arteriovenous fistula (CAVF) is satisfactory. One major drawback of graft stenting is that it is difficult to completely seal off the CAVF and it has recurrence of CAVF and high incidence of in-stent restenosis (ISR) or thrombus. We report a unique case of the patient with recurrent CAVF, ISR, and thrombus who underwent graft stents implantation.

Covered stent for closure of symptomatic plexus-like coronary fistula

Coronary to pulmonary artery fistula are the most frequent congenital anomalies of the coronary arteries. When they are symptomatic they have to be treated in order to prevent complications such as sudden death or myocardial infarction. Surgery is the gold standard for their closure. However an increasing number of reports have shown that interventional cardiology could be a safe and efficient alternative. Plexus-like fistula are composed of multiples and tortuous branches that make them difficult to treat. We report the use of polytetrafluoroethylene-covered (PTFE) stent to cure a plexus-like coronary to pulmonary artery fistula, without associated atherosclerosis, responsible for myocardial ischemia.