Long-term follow-up study of elderly patients with covered stent implantation after coronary perforation

ObjectiveTo evaluate the long-term efficacy of covered stent implantation in the treatment of elderly patients with coronary perforation while undergoing percutaneous coronary intervention （PCI）.MethodsFrom June 2004 to June 2012, our center has followed ten elderly patients （age≥ 60 years） who sustained coronary perforation during PCI. The major adverse cardiac events （MACE） were observed as well. The patients were advised to take 75 mg/day Clopidogrel for two years, and indefinite use of 100 mg/day enteric-coated aspirin.ResultsSix out of the 10 patients aged from 60 to 76 years old （mean 68.6 ± 5.2 years） were male, four were female. The average diameter of the implanted stents was 3.3 ± 0.3 mm, and the average length was 22.1 ± 3.7 mm. All the ruptures were successfully sealed without intra-procedural death. The follow-up duration ranged from 0.6 to 67 months （mean 31.7 ± 24.5 months）. One patient died of multiple organ failure due to lung infection in 19 days after PCI; one died of cardiac sudden death in 13 months after PCI; one had angina pectoris in 53 months after PCI; one underwent multi-slice CT examination in six months after PCI, and no in-stent restenosis was found. The other four patients received angiography follow-up, and the results showed that three patients had no intra-stent restenosis, while one had left anterior descending （LAD） restenosis in the covered stent in 67 months after PCI. The in-hospital mortality was 10% （1/10）. The MACE rate in 12 months after PCI was 10% （1/10）. During the entire followed-up period, the restenosis rate in target vessels was 20% （1/5）, mortality was 20% （2/10）, and the MACE rate was 40% （4/10）.ConclusionTreatment of coronary perforation by using covered stents can achieve favorable long-term results; a two-year dual antiplatelet therapy （DAPT） after PCI can effectively prevent intra-stent thrombosis.

Dissecting Sub-epicardial Hematoma Due to Coronary Perforation and Non-developing Stent

We report a 65-year-old man who presented with anastomotic perforation of the distal right coronary artery due to stent deployment, complicated by a small and stable dissecting sub-epicardial hematoma, and non-developing stent. The cause was unknown.

SUCCESSFUL TREATMENT OF CORONARY ARTERY PERFORATION WITH EMERGENCY INTRACORONARY COATED STENT IMPLANTATION

Coronary artery perforation is a rare but catatrophic complication of percutaneous coronary intervention.We report a case of type Ⅲ coronary artery perforation following stenting at calcified mid-segment of left anterior descending artery.The perforation was successfully covered using a PTFE-coated stent with an excellent clinical and angiographic outcomes.

Prognostic implications of creatine kinase-MB elevation after percutaneous coronary intervention results from the evaluation of drug-eluting stents and ischemic events (EVENT) registry

Background Creatine kinase-MB （CK-MB） elevation after been associated with increased risk for mortality. Although most infarction （pMI） as an elevation in CK-MB 〉 3 × upper limit of and variation in site-specific definitions of the ULN may limit the percutaneous coronary intervention （PCI） has studies have defined periprocedural myocardial normal （ULN）, use of different CK-MB assays value of such relative thresholds.

Comparison of in-hospital and long-term outcomes between a Cypher stent and a Taxus stent in Chinese diabetic patients with coronary artery disease

Background The sirolimus and paclitaxel distribution patterns and tissue residence time may be modified in atherosclerotic lesions for patients with diabetes, and the biological mechanisms of action for these agents differ significantly. Previous clinical trials have yielded discrepant results of major adverse cardiac events and restenosis between a sirolimus-eluting stent and a paclitaxel-eluting stent in coronary artery disease. Therefore, this study was conduced to compare in-hospital and long-term clinical outcomes between patients receiving sirolimus-eluting stent （Cypher or Cypher Select stent） and paclitaxel-eluting stent （Taxus Express stent） after percutaneous intervention （PCI） in Chinese patients with diabetes. Methods One hundred and sixty-four consecutive diabetic patients underwent PCI in Fuwai Hospital from April 2004 to December 2004. Of them, 101 patients received Cypher or Cypher Select stents （Cypher group, 145 stents） and 63 patients received Taxus Express stents （Taxus group, 129 stents）. Repeat coronary angiography was performed at 6-month and clinical outcomes were evaluated at 1- and 3-year follow-up. Stent thrombosis was classified according to Academic Research Consortium （ARC）. Results The two groups did not differ significantly with respect to cardiac death, recurrent myocardial infarction （re-MI）, target vessel revascularization （TVR） and occurrence of major adverse cardiac events （MACE）. And the MACE-free cumulative survival at 1- and 3-year follow-up and early, late and very late thrombosis rates were also similar in the two groups （all P〉0.05）. There was a trend favoring PES over SES with regard to reducing cardiac death （0 vs 2.0%, P=-0.524）, re-MI （0 vs 2.0%, P=-0.524）, the composite of the cardiac death and re-MI （0 vs 4.0%, P=-0.299） and very late thrombosis （0 vs 3.0%, P=-0.295） between 1-year and 3-year follow-up. Conclusion The study indicates that PCI with either Cypher or Taxus stents is associated with similar efficacy and safety in the small population of Chinese diabetic patients during long-term follow-up.