open access
“Burying” covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency
, 1, 1, 1, 1, 1, 1, 1, 1
Affiliations- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucern, Switzerland
open access
Abstract
Background: Covered coronary stent (CS) implantation is associated with a high risk for in-stent
restenosis (ISR) and stent thrombosis (ST). We describe the outcomes after overstenting (“burying”)
CS using contemporary drug-eluting stents (DES).
Methods: We analyzed short- and long-term outcomes of consecutive patients who had had a CS implanted,
which was consecutively covered (“buried”) with a third-generation DES. CSs were primarily
post-dilated and then covered with a longer DES overlapping the proximal and distal edges of the CS.
To ensure optimal stent expansion and appositions, all lesions were post-dilated using adequately sized
non-compliant balloons.
Results: Between 2015 and 2020, 23 patients (mean age 67 ± 14 years, 74% males) were treated using
this novel approach. Reasons for implanting CS included treatment of coronary aneurysms (n = 7;
30%), coronary perforations (n = 13; 57%), and aorto-ostial dissections (n = 3; 13%). All CSs were
successfully deployed, and no peri-procedural complications occurred. The median time of follow-up
was 24.5 (interquartile range [IQR] 11.7–37.9) months. All patients had a 1-month follow-up (FU)
and 19/23 (83%) patients had 12-month FU (FU range 1–60 months). No probable or definite STs
occurred, and no cardiovascular deaths were observed. Among patients undergoing angiographic FU
(11/23 [48%]), 1/23 showed angiographically significant ISR 6 months post CS implantation.
Conclusions: Burying a coronary CS under a DES appears to be a safe and promising strategy to
overcome the limitations of the currently available CS devices, including a relatively high risk for target
lesion failure due to ISR and ST.
Abstract
Background: Covered coronary stent (CS) implantation is associated with a high risk for in-stent
restenosis (ISR) and stent thrombosis (ST). We describe the outcomes after overstenting (“burying”)
CS using contemporary drug-eluting stents (DES).
Methods: We analyzed short- and long-term outcomes of consecutive patients who had had a CS implanted,
which was consecutively covered (“buried”) with a third-generation DES. CSs were primarily
post-dilated and then covered with a longer DES overlapping the proximal and distal edges of the CS.
To ensure optimal stent expansion and appositions, all lesions were post-dilated using adequately sized
non-compliant balloons.
Results: Between 2015 and 2020, 23 patients (mean age 67 ± 14 years, 74% males) were treated using
this novel approach. Reasons for implanting CS included treatment of coronary aneurysms (n = 7;
30%), coronary perforations (n = 13; 57%), and aorto-ostial dissections (n = 3; 13%). All CSs were
successfully deployed, and no peri-procedural complications occurred. The median time of follow-up
was 24.5 (interquartile range [IQR] 11.7–37.9) months. All patients had a 1-month follow-up (FU)
and 19/23 (83%) patients had 12-month FU (FU range 1–60 months). No probable or definite STs
occurred, and no cardiovascular deaths were observed. Among patients undergoing angiographic FU
(11/23 [48%]), 1/23 showed angiographically significant ISR 6 months post CS implantation.
Conclusions: Burying a coronary CS under a DES appears to be a safe and promising strategy to
overcome the limitations of the currently available CS devices, including a relatively high risk for target
lesion failure due to ISR and ST.
Keywords
stents, covered stent, aneurysm, perforation, target lesion failure, in-stent restenosis, percutaneous coronary intervention
Supp./Additional Files (1)
About this articleTitle
“Burying” covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency
Journal
Issue
Article type
Original Article
Pages
196-203
Published online
2021-08-17
Page views
3195
Article views/downloads
842
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(2):196-203.
Keywords
stents
covered stent
aneurysm
perforation
target lesion failure
in-stent restenosis
percutaneous coronary intervention
Authors
Matthias Bossard
Giacomo Maria Cioffi
Mustafa Yildirim
Federico Moccetti
Mathias Wolfrum
Adrian Attinger
Stefan Toggweiler
Richard Kobza
Florim Cuculi
References (24)- Xenogiannis I, Brilakis E. Advances in the treatment of coronary perforations. Catheter Cardiovasc Interv. 2019; 93(5): 921–922.
- Kawsara A, Núñez Gil IJ, Alqahtani F, et al. Management of Coronary Artery Aneurysms. JACC Cardiovasc Interv. 2018; 11(13): 1211–1223.
- Copeland KA, Hopkins JT, Weintraub WS, et al. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv. 2012; 80(1): 53–57.
- Nagaraja V, Schwarz K, Moss S, et al. Outcomes of patients who undergo percutaneous coronary intervention with covered stents for coronary perforation: A systematic review and pooled analysis of data. Catheter Cardiovasc Interv. 2020; 96(7): 1360–1366.
- Kandzari DE, Birkemeyer R. PK Papyrus covered stent: Device description and early experience for the treatment of coronary artery perforations. Catheter Cardiovasc Interv. 2019; 94(4): 564–568.
- Kufner S, Schacher N, Ferenc M, et al. Outcome after new generation single-layer polytetrafluoroethylene-covered stent implantation for the treatment of coronary artery perforation. Catheter Cardiovasc Interv. 2019; 93(5): 912–920.
- Jurado-Román A, Rodríguez O, Amat I, et al. Clinical outcomes after implantation of polyurethane-covered cobalt-chromium stents. Insights from the Papyrus-Spain registry. Cardiovasc Revasc Med. 2020 [Epub ahead of print].
- Ravi S, Chaikof EL. Biomaterials for vascular tissue engineering. Regen Med. 2010; 5(1): 107–120.
- Goh ET, Wong E, Farhatnia Y, et al. Accelerating in situ endothelialisation of cardiovascular bypass grafts. Int J Mol Sci. 2014; 16(1): 597–627.
- Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013; 368(3): 254–265.
- Farb A, Sangiorgi G, Carter AJ, et al. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999; 99(1): 44–52.
- Kilic ID, Fabris E, Serdoz R, et al. Coronary covered stents. EuroIntervention. 2016; 12(10): 1288–1295.
- Ryan TJ, Bauman WB, Kennedy JW, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1993; 88(6): 2987–3007.
- Mintz GS, Popma JJ, Pichard AD, et al. Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation. 1995; 91(7): 1959–1965.
- Ellis SG, Ajluni S, Arnold AZ, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994; 90(6): 2725–2730.
- Thygesen K, Alpert J, Jaffe A, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138(20): e618–e651.
- Cutlip DE, Windecker S, Mehran R, et al. Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007; 115(17): 2344–2351.
- Cuculi F, Puricel S, Jamshidi P, et al. Optical coherence tomography findings in bioresorbable vascular scaffolds thrombosis. Circ Cardiovasc Interv. 2015; 8(10): e002518.
- von Stempel C, Fayed H, Goode JA, et al. Viabahn stent graft in the management of a grade 3 coronary perforation. CVIR Endovasc. 2019; 2(1): 6.
- Ly H, Awaida JPS, Lespérance J, et al. Angiographic and clinical outcomes of polytetrafluoroethylene-covered stent use in significant coronary perforations. Am J Cardiol. 2005; 95(2): 244–246.
- Lansky AJ, Yang Ym, Khan Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006; 98(3): 370–374.
- Wang HJ, Lin JJ, Lo WY, et al. Clinical outcomes of polytetrafluoroethylene-covered stents for coronary artery perforation in elderly patients undergoing percutaneous coronary interventions. Acta Cardiol Sin. 2017; 33(6): 605–613.
- Pavani M, Cerrato E, Latib A, et al. Acute and long-term outcomes after polytetrafluoroethylene or pericardium covered stenting for grade 3 coronary artery perforations: Insights from G3-CAP registry. Catheter Cardiovasc Interv. 2018; 92(7): 1247–1255.
- Rosseel L, Scott B, Prihadi E, et al. Is a covered stent justifiable in the treatment of coronary artery perforation? An observational analysis of long-term results of two different covered stent types. Catheter Cardiovasc Interv. 2019; 93(3): 419–425.
