Background: Iatrogenic coronary perforation
is a rare life threatening complication of percutaneous coronary interventions (PCI) occurring in 0.1–0.8% of cases. Covered stents are the mainstay of therapy for coronary perforation. However, polytetrafluoroethylene (PTFE) covered stents are bulky with limited flexibility making rapid deployment in times of need a challenge. Thus, covered stents are reserved to perforations in proximal or mid straight segments where their delivery is relatively easy. Pericardial covered stent (PCS) is a highly deliverable fully covered stent that may be
used to treat coronary perforations. Only a single case have been reported of the use of this stent in its previous version for the treatment of coronary perforation.
Methods: The databases of two tertiary medical centers were retrospectively reviewed
for cases of coronary perforations in which PCS was used. During a five years
period, between 2008 and 2013, six cases of perforations for which balloon
dilatation was not sufficient were identified.
Results: All patients but one were admitted with an acute coronary syndrome.
Perforations were treated initially with proximal balloon inflation followed by
PCS deployment. The coronary anatomy in which the stents were used was challenging
in most cases. In one case the stent was deployed through a highly tortuous
RIMA and advanced via an existing stent. Four cases warranted the crossing of
highly calcified vessels, with or without an existing stent. In all cases, PCS
deployment resulted in perforation sealing with good angiographic result. In
addition, angiographic follow-up in two patients demonstrates good late vessel
patency. Thus, this report highlights this percutaneous therapeutic alternative
to coronary perforations as safe and effective in challenging anatomies,
reducing the need for emergency surgery.
Conclusions: Coronary perforations are a life
threatening complication of PCI. Pericardial covered stents offer a safe and
effective therapy when balloon inflation and reversal of anticoagulation are
insufficient. PCSs are highly deliverable in challenging situations and
tortuous vessels and thus their prompt use should be considered as first line
therapy for coronary perforations.
