Serial observation of PK Papyrus covered stent implantation for coronary artery perforation by optical coherence tomography and coronary angioscopy: a case report

Background Coronary artery perforation is a rare but life-threatening complication of percutaneous coronary intervention. We present a case of coronary artery perforation treated with a PK Papyrus covered stent. Neointimal coverage evaluation was performed using optical coherence tomography (OCT) and coronary angioscopy (CAS) at 3 and 9 months after stent implantation. Case summary A 63-year-old man was admitted to our hospital with worsening effort angina over 3 months. Coronary angiography revealed severe stenosis in the proximal segment of the left anterior descending artery. After stent implantation, coronary artery perforation occurred. We immediately sealed the perforation site using a PK Papyrus covered stent. The patient was discharged on postoperative day 4. OCT and CAS revealed incomplete neointimal coverage at the PK Papyrus covered stent strut 3 months after stent implantation. At 9 postoperative months, complete neointimal coverage was observed. We continued clopidogrel and edoxaban, but no clinical adverse events were encountered during the follow-up. Discussion To the best of our knowledge, this is the first report of a serial observation of PK Papyrus covered stent implantation for coronary artery perforation using OCT and CAS. In this case, OCT and CAS revealed complete neointimal coverage, without obvious thrombus, 9 months after PK Papyrus implantation. Based on the OCT and CAS findings, our report presents an appropriate follow-up strategy for the prevention of stent thrombosis when using a PK Papyrus covered stent, which will contribute to future research on the appropriate duration of dual antiplatelet therapy and evaluation of neointimal coverage.