Case Report
Very Late Stent Fracture Associated With a Sirolimus-eluting Stent

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Late stent thrombosis (>1 year after implantation) is a recognised complication involving drug-eluting stents. Stent fracture is increasingly being reported as a complication of drug-eluting stent, and in particular sirolimus-eluting stent use. We report the case of very late sirolimus-eluting stent fracture resulting in an acute coronary syndrome. This case report highlights the need for greater awareness and post-marketing surveillance to detect a potential mechanism for late stent thrombosis in the drug-eluting stent era.

Introduction

The use of drug-eluting stents has been demonstrated to lower in-stent restenosis (ISR) rates, however the incidence of late complications such as stent thrombosis has raised concern over their use. In addition, there has been increasing awareness of stent fracture as a potential complication following drug-eluting stent implantation. We report a case of sirolimus-eluting stent (SES) fracture precipitating acute coronary syndrome more than 3 years after stent deployment.

Section snippets

Case History

A 65-year-old man underwent coronary angiography for investigation of exertional angina. This confirmed critical lesions in the first obtuse marginal branch of the circumflex artery (Fig. 1) with minor disease elsewhere and normal left ventriculography. Percutaneous coronary intervention to the culprit lesion was undertaken. The lesion was pre-dilated with 2.0 mm × 10 mm conventional angioplasty balloon to 12 atm., followed by deployment of a 2.75 mm × 30 mm SES to 12 atm., with an excellent final result

Discussion

Despite substantial clinical experience with drug-eluting stents in randomised trials and post-marketing registry surveillance, coronary stent fracture has not been highlighted as a significant clinical issue in the published literature. Nonetheless, awareness of this possible complication has recently begun to emerge with the publication of isolated case reports and small series. One such series suggested the prevalence of stent fracture may be as high as 1.9%,1 with stent fracture occurring

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