Correspondence

Coronary-Artery Rupture Treated with a Polytetrafluoroethylene-Coated Stent

N Engl J Med 2000; 342:1922-1924June 22, 2000

Article

To the Editor:

Coronary-artery rupture is a rare but well-recognized complication during percutaneous revascularization1 that usually requires urgent surgical intervention and often has a poor or fatal outcome. The management of coronary-artery rupture is becoming an increasingly important issue in interventional cardiology as high-pressure balloon inflation is advocated to ensure maximal expansion and optimal deployment of a coronary stent, thereby minimizing the risk of subsequent tissue proliferation within the stent and restenosis.2

There are few reports of percutaneous techniques that have been used successfully to treat this complication. These techniques include vessel occlusion by microcoil and spring embolization and the use of stents covered with vascular graft or synthetic material to seal the rupture site.3,4 The recently introduced Jostent consists of two coaxially aligned stainless-steel stents welded at both ends with a sleeve-like polytetrafluoroethylene membrane sandwiched between the two along their entire length.

A 72-year-old female smoker with hypertension, hypercholesterolemia, and non-insulin-dependent diabetes presented with worsening angina and an occluded right coronary artery (Figure 1AFigure 1Left Anterior Oblique Angiographic Images Showing the Use of a Polytetrafluoroethylene-Coated Stent to Seal a Coronary-Artery Rupture.). We performed angioplasty of the right coronary artery through the right femoral artery, with 10,000 units of heparin given at the outset, which is our standard practice. The occlusion was crossed with a guide wire, and a 24-by-3.0-mm stent was deployed at an inflation pressure of 12 atmospheres, with an additional, 30-by-3.5-mm, stent placed proximally at an inflation pressure of 14 atmospheres. On angiographic assessment, the proximal stent appeared to be underdeployed and was reinflated to 20 atmospheres. At this point, there was evidence of extravasation of contrast material, which was followed by a major coronary rupture (Figure 1B). An occlusive balloon was immediately inflated at the point of leakage, and a 16-by-3.5-mm polytetrafluoroethylene-coated Jostent was then deployed to seal the rupture (Figure 1C). There was a small pericardial effusion but no evidence of tamponade on transthoracic echocardiography, and it was not necessary to reverse the effect of heparin with protamine after the procedure. Despite a moderate elevation of the creatine kinase level, to 188 U per liter, the patient had an uneventful recovery and was discharged home four days later.

The polytetrafluoroethylene-coated stent provided a safe and effective means of sealing a major coronary-artery rupture and avoiding cardiac surgery. Our experience validates the limited reports of the use of covered stents in the management of this serious and potentially fatal complication of coronary angioplasty.3-5

Thuraia Nageh, M.R.C.P.
Martyn R. Thomas, M.D., F.R.C.P.
King's College Hospital, London SE5 9RS, United Kingdom

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Citing Articles (7)

Citing Articles

1. 1

   Rafael Romaguera, Ron Waksman. (2011) Covered stents for coronary perforations. Catheterization and Cardiovascular Interventions 78:2, 246-253
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2. 2

   Catalina Trana, Olivier Muller, Christan Roguelov, Eric Eeckhout. (2011) Deciding on the best course of action for grade III coronary perforations. Interventional Cardiology 3:3, 321-327
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3. 3

   Yue-Qi Zhu, Ming-Hua Li, Jian Xie, Hua-Qiao Tan, Ying-Sheng Cheng, Jian-Bo Wang. (2010) Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study. European Radiology 20:8, 1974-1984
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4. 4

   Reto Gamma, Martyn R. Thomas. (2007) Successful nonsurgical treatment of left main stem perforation by sacrifice of the LAD. Catheterization and Cardiovascular Interventions 69:6, 845-849
   CrossRef

5. 5

   M.C. Petrie, J.O.J. Peels, G. Jessurun. (2006) The role of covered stents: More than an occasional cameo?. Catheterization and Cardiovascular Interventions 68:1, 21-26
   CrossRef

6. 6

   Mari-Liis Kaljusto, Stein Koldsland, Oystein Arild Vengen, Per Reidar Woldbaek, Theis Tonnessen. (2006) Cardiac Tamponade Caused by Acute Spontaneous Coronary Artery Rupture. Journal of Cardiac Surgery 21:3, 301-303
   CrossRef

7. 7

   Martin Hinterseer, Alexander Becker, Peter Steinbigler, Michael Nbauer, Peter Boekstegers. (2002) Interventional treatment of giant pseudoaneurysm with subsequent decompression of internal mammaria bypass. Catheterization and Cardiovascular Interventions 57:4, 525-528
   CrossRef