Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures

Background-Coronary perforation is a life-threatening complication of percu taneous interventions. In the past few years, the implantation of covered s tents has emerged as a strategy for treatment when the traditional conserva tive approach (ie, prolonged balloon inflation and reversal of anticoagulat ion) fails. Methods and Results-Since May 1997 (when polytetrafluoroethylene [PTFE]-cov ered stents were available at our institutions), 11 of the 12 consecutive p atients who had coronary ruptures that were unsuccessfully sealed with prol onged balloon inflation and reversal of anticoagulation were treated with 1 2 PTFE-covered stents (PTFE group). The efficacy of the PTFE-covered stent was compared with that of noncovered stents, which were used to treat 17 pe rforations (non-PTFE group). One patient sustained a very distal perforatio n that was not suitable for covered stent sealing and underwent emergency s urgery. All vessel ruptures treated with PTFE-covered stent implantation we re successfully sealed. The time necessary to deploy the stent was 10+/-3 m inutes (range, 4 to 15 minute). All patients but one were discharged from t he hospital and had an optimal early clinical outcome. One patient underwen t emergency bypass surgery and died in the intensive care unit. The occurre nce of cardiac tamponade and the necessity for emergency surgery was signif icantly lower in the PTFE group than in the non-PTFE group. At 14 +/- 4 mon ths, the 10 discharged patients had not experienced any major adverse cardi ac events. Conclusions-This preliminary study supports the utility of the PTFE-covered stent for the nonsurgical treatment of vessel ruptures.