A case of repeated stent fracture

Abstract

Stent fracture is one of the complications of drug-eluting stent implantation. An 84-year-old man underwent coronary angiography for unstable angina. He had diffuse severe stenosis and calcified plaque in the left anterior descending artery and underwent percutaneous coronary intervention (PCI) in the left anterior descending artery for severe stenosis with chest pain. Thereafter, two subsequent stent fractures occurred, so the patient underwent another PCI to cover them. However, a stent fracture was found again one year later. The patient was asymptomatic and PCI was avoided due to the risk of further stent fracture. When a stent fracture occurs, it is important to provide appropriate treatment according to the anatomical findings of the vessel, symptoms and the presence of ischemia.

Keywords: drug-eluting stent; everolimus-eluting stent; percutaneous coronary intervention; stent fracture.

Figure 1

First PCI: Angiogram of LAD showed diffuse severe stenosis (A) and calcified plaque on intravascular ultrasound (B), and two stents (1; XIENCE Skypoint 3.0 × 48 mm, 2; XIENCE Skypoint 2.25 × 15 mm) were implanted (C).

Figure 2

Second PCI: CCTA showed two stent fractures (A), and angiogram of LAD also showed two stent fractures and new stenosis (B and C).

Figure 3

Follow-up CAG: A new stent fracture was confirmed by CCTA (A), and angiogram of LAD showed a stent fracture at the stent duplex (1; XIENCE Skypoint 3.0 × 48 mm, 2; XIENCE Skypoint 2.25 × 15 mm, 3; SYNERGY XD 2.25 × 38 mm) (B and C).