Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Procedural and 1-year Outcomes Following Large Vessel Coronary Artery Perforation Treated by Covered Stents Implantation: Multicentre CRACK Registry
Wojciech Wańha1, Rafał Januszek2, Łukasz Kuźma3, Tomasz Figatowski4, Michalina Kołodziejczak5, Magdalena Żak6, Malwina Smolarek1, Monika Gruz-Kwapisz1, Maciej Wybraniec1, Mateusz Tajstra7, Brunon Tomasiewicz8, Andrzej Łoś4, Dariusz Jagielak4, Tomasz Roleder1, Adrian Wlodarczak9, Jakub Kulczycki9, Damian Hudziak1, Pawel Stachowiak10, Krzysztof Reczuch8, Miłosz Jaguszewski4, Sławomir Dobrzycki3, Grzegorz Smolka1, Stanisław Bartuś2, Andrzej Ochala1, Mariusz Gąsior7, Wojciech Wojakowski1
Medical University of Silesia, Poland1, Jagiellonian University Medical College, Poland2, Medical University of Białystok, Poland3, Medical University of Gdansk, Poland4, Ludwik Rydygier Collegium Medicum, Poland5, Medical University Of Silesia, Poland6, Medical University of Katowice, Poland7, Wroclaw Medical University, Poland8, Miedziowe Centrum Zdrowia S.A., Poland9, Regional Specialist Hospital, Poland10
Data regarding the use of covered stents (CSs) to seal coronary artery perforations (CAPs) on a daily clinical basis are scarce.
The aim of the CRACK Registry was to evaluate the procedural 30-days and 1-year outcomes after CAP treated by CS implantation.
The multicenter registry consists of 119 consecutive patients with iatrogenic CAP treaded by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACE) defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). The study was conducted in accordance with the Declaration of Helsinki and was registered at ClinicalTrials.gov (NCT04630314).
The mean age of study participants was 68±9.6 years, and 55.5% were men. Acute coronary syndrome (ACS) including unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%) was the presenting diagnosis in 61.3% of patients, and chronic coronary syndromes in 38.3% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) cases. A total of 52 patients (43.6%) had type 3 lesion by Ellis classification, 28 (23.5%) had type 2 lesion, followed by 40 patients (33.6%) with type 1 lesion. Complex PCI, such as CTO, tortuosity, bifurcation, or severe calcification, was observed in 70 (58.8%) of patients. Periprocedural death was observed in eight patients (6.7%), of which two patients had emergency cardiac surgery.
Successful embolization occurred in 99 (83.2%) patients; among those 26 (26.2%) patients during one-year follow-up experienced MACE, 7 (7.0%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs, and 6 (6.0%) stent thrombosis (ST) with 4(4%) acute ST, 1(1%) subacute ST and 1(1%) late ST.
The procedural and 1-year outcomes of CAP treated by CS implantation are favorable. Prevalence of ST warrants further research with intravascular imaging.