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

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; 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.