open access

Ahead of print
Original Article
Published online: 2021-08-17
Get Citation

“Burying” covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency

Matthias Bossard, Giacomo Maria Cioffi, Mustafa Yildirim, Federico Moccetti, Mathias Wolfrum, Adrian Attinger, Stefan Toggweiler, Richard Kobza, Florim Cuculi
DOI: 10.5603/CJ.a2021.0096
·
Pubmed: 34490602

open access

Ahead of print
Original articles
Published online: 2021-08-17

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.

Get Citation

Keywords

stents, covered stent, aneurysm, perforation, target lesion failure, in-stent restenosis, percutaneous coronary intervention

Supp./Additional Files (1)
Supplemental Figure 1. Case vignette of a patient presenting with in-stent restenosis after overstenting (“burying”) the covered stent with one drug eluting stent. (A) Demonstrates a heavily calcified ostial right coronary artery (RCA) lesion (the arrow
View
1MB
About this article
Title

“Burying” covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-08-17

DOI

10.5603/CJ.a2021.0096

Pubmed

34490602

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)
  1. Xenogiannis I, Brilakis E. Advances in the treatment of coronary perforations. Catheter Cardiovasc Interv. 2019; 93(5): 921–922.
  2. Kawsara A, Núñez Gil IJ, Alqahtani F, et al. Management of Coronary Artery Aneurysms. JACC Cardiovasc Interv. 2018; 11(13): 1211–1223.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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].
  8. Ravi S, Chaikof EL. Biomaterials for vascular tissue engineering. Regen Med. 2010; 5(1): 107–120.
  9. 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.
  10. Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013; 368(3): 254–265.
  11. Farb A, Sangiorgi G, Carter AJ, et al. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999; 99(1): 44–52.
  12. Kilic ID, Fabris E, Serdoz R, et al. Coronary covered stents. EuroIntervention. 2016; 12(10): 1288–1295.
  13. 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.
  14. 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.
  15. 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.
  16. Thygesen K, Alpert J, Jaffe A, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138(20): e618–e651.
  17. 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.
  18. Cuculi F, Puricel S, Jamshidi P, et al. Optical coherence tomography findings in bioresorbable vascular scaffolds thrombosis. Circ Cardiovasc Interv. 2015; 8(10): e002518.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl