Two cases of immediate stent fracture after zotarolimus-eluting stent implantation

Abstract

Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease. However, previous reports indicate that stent fractures, which usually occur after a period of time from the initial DES implantation, have increased during the DES era; stent fractures can contribute to unfavorable events such as in-stent restenosis and stent thrombosis. In our present report, we describe two cases of zotarolimus-eluting stent fracture: one that was detected six hours after implementation, and the other case that was detected immediately after deployment. Both anatomical and technical risk factors contributed to these unusual cases of immediate stent fracture.

Keywords: Complications; Drug-eluting stents; Percutaneous coronary intervention.

Fig. 1

Serial coronary angiograms in case 1. A: normal right coronary angiogram. B: right coronary angiogram showing intraluminal spiral-shaped filling defect from proximal to distal artery. C: fluoroscopic imaging shows complete linear transverse fracture (arrow) of the implanted stent. D: there is no evidence of flow obstruction at the fracture site. Note the compromised right ventricular branches in B and D.

Fig. 2

Representative coronary angiographic and IVUS findings in case 2. A: AP caudal view of coronary angiogram shows diffuse eccentric stenosis from ostium to mid-portion of left anterior descending artery. B: fluoroscopic image shows gap (arrow) at the border of distally implanted stent suspicious of stent fracture. C: small indentation (arrow) is noted at the site of gap during angiogram. D, E, and F: serial IVUS images revealed partial absence of the metallic stent strut corresponding to the area of the gap. IVUS: intravascular ultrasound.