Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft

Am J Cardiol. 2006 Aug 1;98(3):370-4. doi: 10.1016/j.amjcard.2006.02.041. Epub 2006 Jun 12.


Coronary artery perforation is a rare, but dreaded, complication of percutaneous coronary intervention. Conventional treatment, including reversal of anticoagulation and prolonged balloon inflation, is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Although a number of case reports have demonstrated the feasibility of sealing coronary perforations with synthetic material-covered stent grafts, the efficacy of this treatment has not been reported in a large, multicenter series. We used a retrospective international registry to examine the outcomes of the polytetrafluoroethylene-coated JOSTENT coronary stent graft (CSG) in 41 cases of coronary perforations. Perforations were relatively severe: 16.7% Ellis grade 1, 54.2% grade 2, and 29.1% grade 3. Of the 41 patients, > 1/3 (n = 14) experienced life-threatening complications before stent graft implantation, including pericardial tamponade (12.2%), cardiogenic shock (9.8%), and cardiac arrest (2.4%). A total of 52 CSGs were used to treat the 41 perforations (mean 1.3 per lesion). All CSGs were placed successfully, with 92.9% of the perforations sealed completely and 7.1% partially. One patient developed abrupt vessel closure after CSG deployment, resulting in an overall procedure success rate of 96.4%. No in-hospital Q-wave myocardial infarctions, emergency coronary bypass surgeries, or deaths resulted. The CSG may be a reliable and highly effective treatment option for sealing coronary perforations complicating percutaneous coronary interventions.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Cineangiography
  • Coated Materials, Biocompatible*
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / therapy*
  • Coronary Vessels / injuries*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Polytetrafluoroethylene*
  • Prognosis
  • Prosthesis Design
  • Retrospective Studies
  • Rupture
  • Stents*


  • Coated Materials, Biocompatible
  • Polytetrafluoroethylene