Case ReportVery Late Stent Fracture Associated With a Sirolimus-eluting Stent
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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2022, Cardiovascular Revascularization MedicineCitation Excerpt :That bioadaptors allow vessel movement over time may help to attenuate some of the negative consequences seen for conventional coronary stents, for instance stent-related adverse events including stent fractures [9,14]. Additionally, repetitive stress on coronary stents from movements is thought to contribute to this occurrence [14,15], the compliance mismatch may have additional negative consequences such as plaque ruptures at the junction of compliance change. The observed reduction in stress post bioadaptor uncaging in the FEA model, validated in-vivo, may thus also be indicative of a reduced risk of subsequent adverse events including device fractures [7,9].
SUPERA stent outcomes in Above-The-Knee IntervEntions: Effects of COMPression and ELongation (SAKE-COMPEL) Sub-study
2018, Cardiovascular Revascularization MedicineCitation Excerpt :The above findings collectively reflect that patients in the current study had more severe disease with complex lesions compared with SUPERB trial, probably requiring more stents to treat these lesions. Interestingly, longer stented lesion length and stent overlap resulting from using increasing number of stents may elevate the risk of stent fractures, which contributes to re-occlusion and stenosis [18–21]. Decreased stent conformability along longitudinal axis also increases exposure to longitudinal countervailing force of the vessel wall increasing risk of stent fracture [5].
Incidence and Clinical Outcomes of Stent Fractures on the Basis of 6,555 Patients and 16,482 Drug-Eluting Stents From 4 Centers
2016, JACC: Cardiovascular InterventionsCitation Excerpt :In general, RCA stents, stainless stents, longer stents or multiple stents, and overlapping stents were universally accepted to be correlated with SF (13–17). RCA stents, particularly in the proximal-to-middle segment of the RCA, were most commonly exposed to severe cardiac motion and angulation, a mechanical mechanism causing stent fracture (9,10). Once longer or multiple or overlapping stents were used, aggressive post-dilation was usually performed to achieve optimal angiographic results (11–18), which was consistent with our findings that patients with SF had more frequent multivessel disease requiring multiple and longer stents followed by post-dilation at a higher pressure.
Long-term clinical and angiographic outcomes of patients with sirolimus-eluting stent fracture
2012, International Journal of CardiologyCitation Excerpt :Drug-eluting stents (DES) have become the gold standard for treating symptomatic coronary artery disease because of their reduced incidence of in-stent restenosis (ISR) [1,2]. Although the incidences of ISR have dramatically decreased with the use of DES, safety concerns such as ISR [3–5] and possibly stent thrombosis [6,7] are known to be associated with stent fracture (SF), which is a complication of DES. SF was first reported after implantation of the stent at the superficial femoral artery [8].
Incidence and Predictors of Drug-Eluting Stent Fracture in Human Coronary Artery. A Pathologic Analysis
2009, Journal of the American College of CardiologyCitation Excerpt :Although stent fracture clinically has been reported to predominantly be associated with restenosis, we had a higher incidence of acute thrombus in our study. Nevertheless, some case reports have described cases of stent thrombosis with stent fracture (9,10). Previous clinical studies have reported that the main risk factors for stent fracture are longer stent length, RCA or saphenous vein graft lesion location, lesion with high motion, overlapping stent, and Cypher stent use (6,8,14).
Stent Gap by 64-Detector Computed Tomographic Angiography. Relationship to In-Stent Restenosis, Fracture, and Overlap Failure
2009, Journal of the American College of Cardiology