Advances in the treatment of coronary perforations

Coronary artery perforation is an infrequent, but potentially life-threatening complication of percutaneous coronary intervention. There are four types of coronary perforation: (a) large vessel; (b) distal vessel; (c) septal collateral; and (d) epicardial collateral perforation. Implantation of a covered stent is the cornerstone of large vessel perforation treatment and can be used in some distal vessel perforations, when embolization is not feasible. Until now the only available covered stent in the US was the Graftmaster stent (two bare metal stents with a PTFE membrane in-between them), that has high profile and is challenging to deliver and expand. Use of the Graftmaster has been associated with high rates of in-stent restenosis and stent thrombosis. Availability of more deliverable covered stents, such as the BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) and PK Papyrus (BIotronik, Lake Oswego, Oregon, that recently received FDA approval) will greatly facilitate treatment of large vessel coronary perforations.