Stent fracture after everolimus-eluting stent implantation

Abstract

Compared with bare-metal stents, drug-eluting stents (DES) have greatly reduced the risk of in-stent restenosis (ISR) by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF) has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES) may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs) represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR.

Figure 1

Angiographic images of the right coronary artery with a significant mid-segment calcified stenosis (a) and final result after deployment of a 2.75 × 28 mm and 2.25 × 23 mm Xience V stents (b).

Figure 2

Focal in-stent restenosis of the mid-right coronary artery (a). Complete stent fracture with a clear separation of the stent struts (b). Imaging of the Xience V stent confirming no separation between struts at the original stent procedure (B1).

Figure 3

Angiographic images of the left anterior descending artery after two Xience V and one Promus stent deployment showing the absence of stent strut separation (a) and the presence of a good angiographic result (b).

Figure 4

Focal in-stent restenosis of the mid- and distal left anterior descending artery (a). Double stent fracture with complete strut separation in two different locations (b).

Figure 5

Angiographic images of the left anterior descending artery after two Endeavor stents deployment showing the absence of stent strut separation (a) and the presence of a good angiographic result (b).

Figure 6

Complete Endeavor stent fracture of the distal left anterior descending coronary artery.