PLoS ONE (Jan 2021)

Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry.

  • Wojciech Wańha,
  • Rafał Januszek,
  • Michalina Kołodziejczak,
  • Łukasz Kuźma,
  • Mateusz Tajstra,
  • Tomasz Figatowski,
  • Malwina Smolarek-Nicpoń,
  • Monika Gruz-Kwapisz,
  • Brunon Tomasiewicz,
  • Jerzy Bartuś,
  • Andrzej Łoś,
  • Dariusz Jagielak,
  • Tomasz Roleder,
  • Adrian Włodarczak,
  • Jan Kulczycki,
  • Mariusz Kowalewski,
  • Damian Hudziak,
  • Paweł Stachowiak,
  • Jarosław Gorący,
  • Katarzyna Sierakowska,
  • Krzysztof Reczuch,
  • Miłosz Jaguszewski,
  • Sławomir Dobrzycki,
  • Grzegorz Smolka,
  • Stanisław Bartuś,
  • Andrzej Ochała,
  • Mariusz Gąsior,
  • Wojciech Wojakowski

DOI
https://doi.org/10.1371/journal.pone.0249698
Journal volume & issue
Vol. 16, no. 5
p. e0249698

Abstract

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BackgroundData regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation.MethodsThis multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI).ResultsThe registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST].ConclusionsThe use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.