Objective To evaluate the long-term efficacy of covered stent implantation to the patients with coronary perforation occurred in percutaneous coronary intervention (PCI).
Methods From June 2004 to March 2011, a total of 8 cases received 8 covered stents implantation because of coronary perforation in our centre. Ellis grade III coronary perforation occurred in 7 patients, and Ellis grade I in 1 patient. The patients took clopidogrel 75 mg/d for 2 years, and 100 mg/d for lifetime. The major adverse cardiac events (MACE) were observed in the 8 patients through long-term follow-up.
Results There were 5 males and 3 females in the 8 patients who aged 63–76 (mean 69.3 ± 4.7) years. Six patients had multi-vessel disease. The target vessels were left anterior descending artery (LAD) in 7 patients. Calcified lesions emerged in 3 patients and total occlusion lesions in 3 patients. In addition to 2 patients with balloon dilating after guidewire into the false lumen, the coronary artery perforation of the remaining six patients were associated with too high pressure of stent expansion or balloon dilating. Pericardial tamponade happened in 7 patients, and pericardial effusion of 100–470 ml was drained by pericardiocentesis. Implanted covered stents average diameter was 3.3 ± 0.3mm, and average length was 21.3 ± 4.1mm. All perforation of the patients were successfully closed, while no patients died in PCI. During follow-up of 0.6–67 months (mean 35.3 ± 25.1 months), 2 patients died. Nineteen days after PCI, one patient died of multiple organ failure due to lung infection. Thirteen months after PCI, another patient died of cardiac sudden death. One patient was hospitalised with angina pectoris after 53 months, and the symptoms was relieved. The imaging was not reviewed. After 6 months one patient received multi-slice CT examination, and no restenosis was found. He was currently asymptomatic. The remaining four patients were reviewed coronary angiography after 15–67 months. Only one patient showed LAD stent restenosis and received target vessel revascularization. The remaining 3 patients had no restenosis within the stent. During the entire follow-up, restenosis rate was 20% (1/5), mortality rate was 25% (2/8) and MACE rate was 50% (4/8). If follow-up after PCI was 12 months, MACE rate decreased to 25% (2/8).
Conclusions Treatment of covered stent to coronary perforation can achieve good long-term efficacy. A two-year dual antiplatelet drugs can be effective in preventing covered stent thrombosis.