Clinical Outcomes of Coronary Artery Perforation Treated With Covered Stents: The Impact of Intravascular Ultrasound Guidance in a Contemporary Cohort

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Background Coronary artery perforation (CAP) during percutaneous coronary intervention carries significant morbidity and mortality; however, data are limited regarding the specific role of intravascular ultrasound (IVUS) in evaluating and guiding management after CAP occurs and whether this approach improves clinical outcomes. Methods This study consisted of a retrospective analysis of all patients who underwent percutaneous coronary intervention and experienced CAP treated with covered stents at a single tertiary care hospital between December 2014 and January 2024. The primary outcome was target vessel revascularization (TVR). Secondary outcomes included mortality, myocardial infarction, in-stent restenosis, and emergency cardiac surgery. Multivariable logistic regression was used to assess the association between IVUS and outcomes. Results Between 2014 and January 2024, 127 cases of CAP treated using covered stents were identified. Of these, 34 patients (26.8%) underwent IVUS-guided covered stent optimization, whereas 93 patients (73.2%) did not undergo IVUS. Patients in the IVUS group were older (75.1 ± 8.4 vs 61.0 ± 10.3 years; P < .001) and predominantly women (55.9% vs 31.2%; P = .020). The IVUS was more frequently used for left anterior descending artery perforations (64.7% vs 36.6%; P = .009). IVUS was associated with a reduced risk of TVR during an average follow-up of 60.3 months (adjusted odds ratio, 0.04; 95% CI, 0.02-0.56; P = .031). Other outcomes, including mortality and repeat myocardial infarction, were similar between the 2 groups. Conclusions The use of IVUS in patients requiring covered stents for CAP treatment, despite higher procedural complexity and a higher prevalence of severe perforations, was associated with significantly reduced TVR. This suggests a potential role for IVUS in improving clinical outcomes following CAP.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.