| Background: Percutaneous Coronary Intervention(PCI)is a therapeutic method which refers to the cardiac catheterization technique to dredge the stenosis or occlusion of the coronary artery lumen and reconstructs blood flow of coronary arterial to improve myocardial perfusion.It is a important methed to save dying or ischemic myocardial cells.Therefore,PCI has become the milestone in the field of cardiovascular diagnosis and treatment.Many evidence have been proved that PCI technique can obviously improve the prognosis of patients with coronary heart disease(CHD)and greatly improve the quality of life of patients.At present,PCI technology has been improved in technology,equipment,perioperative management and so on.The number of operations is increasing annually.Such as United States has completed the PCI operation more than 1000000 alone only in 2006.However,with the increase of the amount of surgery and complex lesions,coronary artery perforation(CAP)also showed an increasing trend.CAP is one of the most serious complications of PCI,which can lead to acute cardiac tamponade,acute myocardial infarction and death.It is called the “catheter room nightmare”.A study by Tim Kinnaird et al.[1] included 527121 patients with PCI showed that the incidence of CAP was only 0.33% in 2006-2013,and its incidence has increased from 0.29% in 2006 to about0.34% in 2013.Although the incidence is low,it has a higher incidence of pericardial tamponade and death.A system analysis including 16 studies(197061 cases of PCI operation)showed that[2],CAP induced cardiac tamponade and death incidence for type?CAP were 0.4% and 0.3% respectively,for type ? CAP were 3.3% and 0.4% respectively,while for type ? CAP reached 45.7% and 21.2% respectively.From here we see that the type and adverse events of CAP are closely related,high mortality and high risk are the characteristics of CAP,especially type ? CAP,which is a fatal blow to patients.Covered stent refers to the inner surface or outer surface of metal stent partially or completely coated with special membranous materials(such as PTFE,autologous vein,pericardium,polyethylene for benzene dicarboxylic acid,polyester,polyurethane and so on)on the stent.It not only retains the support function of metal stent and improves the pathological changes of the blood vessels abnormal hemodynamics effectively.So it has been widely used in the treatment of peripheral vascular malformations and acute or chronic vascular injury.With the development of membrane materials of covered stent,it has been gradually applied to the cases of coronary artery perforation in recent years.However,there are relatively few reports about the type ? CAP implanted with covered stent at home and abroad,and there is little understanding of the cause and the long term effect of it.Therefore,this study was to analyze the causes and summarize the clinical outcomes of the type ? CAP that need to be implanted with covered stent,and evaluate the long term efficacy of covered stent.Objective: 1.Describe the distribution characteristics of lesion types of type ? coronary artery perforation with covered stent implantation and analyze the causes of perforation;2.To summarize the clinical outcomes of type ? coronary artery perforation with covered stent implantation during hospitalization and to evaluate the near and long term efficacy of covered stent.Methods: 1.In this study,we selected patients as case group who underwent percutaneous coronary intervention(PCI)in the Department of Cardiology,Xijing Hospital from April 2006 to September 2015,and underwent covered stent implantation after coronary artery perforation.we randomly selected patients from the database as control group who didn't occur coronary perforation in the corresponding year according to the ratio of 1:2.2.Of all patients,a detailed record of the basic information of patients(gender,age,medical history,blood glucose,blood pressure,blood lipid,renal function,ejection fraction,etc.),lesion characteristics(previous PCI or CABG,the location and quantity of crime vascular,vascular calcification,vascular tortuosity,vascular angle,vascular openings,etc.),the reason of perforation(guidewire,balloon and stent),treatment situation,and follow-up angiography on cases were collected.3.Describe the distribution characteristics of lesion types,analyze the reasons,summarize the clinical outcomes during hospitalization,and evaluate the near and long term efficacy of type ? coronary artery perforation with covered stent implantation.Results: A total of 28 cases of type ? coronary artery perforation with covered stent implantation(male 20 cases,female 8 cases)were included in the study.The average age was 66.7±7.5 years old.The number of perforating vessels was anterior descending artery in 20 cases(71.4%),right coronary artery in 6 cases(21.4%)and circumflex artery in 2 cases(7.1%).The classification of vascular lesions in perforating site were respectively type A lesions in 16 cases(57.1%),type C lesions in 11 cases(39.3%),type B2 lesions in 1 case(3.6%).The causes of perforation are post-expansion with stents balloon in 15 cases(53.6%),stents expansion in 6 cases(21.4%),post-expansion balloon in 3 cases(10.7%),pre-expansion balloon in 1 case(3.6%),and guidewire in 3 cases(10.7%),respectively.Pericardial tamponade occurred in 17 cases(60.7%)after perforation.Persistent balloon compression immediately in 14.2%.24 cases(85.7%)were successfully implanted with covered stent,and emergency thoracotomy was performed in 6 patients,including 4 cases of emergency CABG.3 patients(10.7%)died during hospitalization,and 9 cases(32.1%)of the major adverse cardiovascular events(MACE)occurred during operation and hospitalization.7 cases were followed with CAG,and the restenosis(?70%)rate was 42.9%.Conclusion: Age,smoking history,myocardial infarction history were risk factors for type ? coronary artery perforation,and left ventricular ejection fraction,PCI or CABG were protective factors.The type ? coronary perforation with covered stents mainly occurred in the left anterior descending branch and the mainly lesion type is type A and type C.The mainly cause of perforation is post-expansion with stents balloon.The covered stent is an effective way to seal the rupture site with a high success rate but has a high restenosis rate. |
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