TCT-950 Clinical Outcomes of Coronary Artery Perforation Treated with Covered Stents: The Impact of Intravascular Ultrasound Guidance in a Contemporary Cohort

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: Coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) 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 PCI and experienced a coronary perforation at a single tertiary care hospital between December 2014 and January 2024. All included patients underwent PCI with coronary artery perforation treated using covered stents. The primary outcome was target vessel revascularization (TVR). Secondary outcomes included mortality, myocardial infarction (MI), in-stent restenosis, and emergency cardiac surgery. Multivariable logistic regression assessed IVUS’s association with outcomes. Results: Between 2014 and January 2024, 127 cases of CAP during PCI were identified. Of these, 34 patients (26.8%) underwent IVUS-guided 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<0.001) and predominantly female (55.9% vs. 31.2%, p=0.020). IVUS was more frequently used for left anterior descending artery perforations (64.7% vs. 36.6%, p=0.009). IVUS was associated with a reduced risk of TVR during an average 60.3 months of follow-up (adjusted odds ratio: 0.04, 95% confidence interval: 0.02–0.56, p=0.031). Other outcomes, including mortality and repeat MI, were similar between both two groups. Conclusion: IVUS use in patients requiring covered stents for CAP treatment, despite higher procedural complexity and prevalence of severe perforations were associated with significantly reduced TVR, suggesting IVUS's potential role in improving clinical outcomes following CAP. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

Volume

86

Issue

17

First Page

B406

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