Successful sealing of a coronary aneurysm by novel, second-generation, covered stent implantation: first report of optical coherence tomography and coronary angioscopy evaluation.
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ABSTRACT:
SUBMITTER: Koiwaya H
PROVIDER: S-EPMC8360398 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We present a case of iatrogenic aortic haematoma, developed during percutaneous coronary intervention, treated with covered stent implantation followed by a conservative approach characterised by the integration of both clinical and multimodal imaging information. This complication can lead to overt aortic dissection (28-47%), rupture (20-45%) or death (21%). In 10% of the cases it can completely regress. Guidelines for its treatment are debated because of the unpredictable natural history of intramural haematoma. Nowadays, a close follow-up with multimodal imaging is considered a valid strategy for the appropriate management of this severe condition. On the basis of the patient's clinical condition and the information obtained by multiple imaging tests (angiography, transthoracic and transesophageal echocardiography and multidetector CT scan) we decided to treat our patient with medical therapy. To date, a 1-year follow-up negative for cardiac events is recorded.
| S-EPMC5498823 | biostudies-literature
Project description:PurposeWe evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation drug-eluting stent (DES) implantation.Materials and methodsA total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data.ResultsAll 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank).ConclusionAlthough CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.
| S-EPMC6704022 | biostudies-literature
Project description:Abstract Background Intravascular lithotripsy (IVL) is a new modality in treatment of calcified coronary lesions which improves procedural outcomes. Coronary perforation is an extremely uncommon but potentially catastrophic complication of percutaneous coronary intervention (PCI) and IVL therapy. Case summary We report a case of an elective PCI to a calcified left anterior descending (LAD) and diagonal bifurcation lesion in a 65-year-old man. LAD was treated with two stents. Despite high pressure non-compliant balloon inflation, a focal area of under-expansion remained. IVL successfully treated the under-expansion but was complicated with a large coronary perforation. The perforation was successfully sealed with a PK-PAPYRUS covered stent sacrificing the diagonal branch. Patient remained stable until 3 hours later when he developed tamponade requiring urgent pericardial drainage. Repeat angiography demonstrated recanalization of the diagonal branch and ongoing contrast extravasation along its course. Optical coherence tomography intracoronary imaging was used to delineate the mechanism of ongoing bleeding. This demonstrated an interrupted elastic membrane of the covered stent, potentially caused by underlying fractured calcium. Therefore, a second overlying PAPYRUS stent was deployed which satisfactorily sealed the perforation. Discussion IVL is an emerging less invasive treatment for calcified coronary stenosis but could be associated with drastic complications. This case highlights the importance of awareness of IVL-related coronary perforation and the potential limitation of new generation thinner-wall covered stents. Intracoronary imaging plays an important role in identifying mechanisms of stent failure, tailoring treatment, and optimizing outcomes.
| S-EPMC9606236 | biostudies-literature
Project description:We present a case of a ruptured mycotic coronary aneurysm effectively treated with covered stents and phased surgery. The covered stent, however, became occluded two years later. Because of the low invasiveness, a covered stent treatment may be advantageous over conventional surgery but trade off long-term vascular patency.Learning objectiveTo recognize the presence of a ruptured infectious coronary aneurysm after a primary coronary stenting for ST-elevation myocardial infarction.To discuss the treatment strategies for a ruptured infectious coronary aneurysm with a covered stent.
| S-EPMC10562108 | biostudies-literature
Project description:Peripheral artery disease (PAD) is a complex, often underdiagnosed illness with rising prevalence in western world countries. During the past decade there has been a rapid advance especially in the field of endovascular treatment of PAD. Here we present for the first time a case reporting on the placement of coronary stent graft in a peripheral vessel for the management of a peripheral side branch perforation. Interventional angiologists or radiologists may consider such an option for complication management after injury of smaller vessels during peripheral percutaneous interventions. Further specialization and novel options of complication management as described in our case may shift the treatment from surgical to even more endovascular treatment procedures in the future.
| S-EPMC4561936 | biostudies-literature
Project description:The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described. (Level of Difficulty: Advanced.).
| S-EPMC8302797 | biostudies-literature
Project description:BackgroundCoronary artery aneurysms (CAAs) of the left main represent a small subset of coronary artery disease and are associated with cardiovascular death. Because of its rare entity, large data are lacking and therefore treatment guidelines are missing.Case summaryWe describe a case of a 56-year-old female with a past medical history of spontaneous dissection of the distal descending left artery (LAD) 6 years before. She presented to our hospital with a non-ST elevation myocardial infarction and a coronary angiogram showed a giant saccular aneurysm of the shaft of the left main coronary artery (LMCA). Given the risk of rupture and distal embolization, the heart team decided to go for a percutaneous approach. Based on a pre-interventional 3D reconstructed CT scan and guided by intravascular ultrasound, the aneurysm was successfully excluded with a 5 mm papyrus-covered stent. At 3-month and 1-year follow-up, the patient is still asymptomatic and repeat angiographies showed full exclusion of the aneurysm and the absence of restenosis in the covered stent.DiscussionWe describe the successful percutaneous IVUS-guided treatment of a giant LMCA shaft coronary aneurysm with a papyrus-covered stent with an excellent 1-year angiographic follow-up showing no residual filling of the aneurysm and no stent restenosis.
| S-EPMC9972523 | biostudies-literature
Project description:Endovascular repair for brachiocephalic artery aneurysms (BAAs) and subclavian artery aneurysms (SAAs) is often unclear. We treated 2 such cases percutaneously with covered stents. It may be an alternative to surgical repair for patients with isolated BAA or SAA. (Level of Difficulty: Advanced.) Central Illustration
| S-EPMC9207960 | biostudies-literature
Project description: Not available
| S-EPMC8176077 | biostudies-literature
Project description:ObjectivesThe present study aimed to investigate the short- and long-term clinical outcomes of self-made polyurethane-covered stents (PU-CS) in patients for the management of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI).BackgroundCoronary artery perforation is reckoned as a serious complication in PCI and associated with considerable morbidity and mortality. Covered stents have been used for treating the life-threatening CAP during PCI. But in some catheterization laboratories, no commercial CS is immediately available when there is an urgent need for CS to rescue the coronary rupture site.MethodsWe retrospectively identified 24 patients who underwent 31 self-made PU-CS implantations due to CAP in Zhongshan Hospital, Fudan University, from June 2015 to January 2020.ResultsThe total procedural success rate of CS to seal the perforation was 79.2%. Nine patients (37.5%) developed cardiac tamponade, of which 8 patients (33.3%) underwent pericardiocentesis and 4 patients (16.7%) underwent cardiac surgeries. Except for 4 cardiac death cases (16.7%), none of myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) was reported during hospital stay. Data from 22 patients (91.7%) were available at 610.4 ± 420.9 days of follow-up. Major adverse cardiac events (MACE) occurred in 6 patients (27.3%), including 5 cases of cardiac death and one TLR case.ConclusionsSelf-made PU-CS demonstrates high rates of successful delivery and sealing of severe CAP during PCI. Although the in-hospital mortality remains high after PU-CS implantation, the long-term follow-up shows favorable clinical outcomes, indicating the feasibility of PU-CS in treating CAP.
| S-EPMC8143889 | biostudies-literature