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

Lee PH, Lee SW, Lee JY, Kim YH, Lee CW, Park DW, Park SW, Park SJ - Korean Circ J (2015)

Bottom Line: Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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Figure 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.

Mentions: A 62-year-old man, who had undergone cardiac transplantation for advanced heart failure, was referred to our catheterization laboratory for a regular surveillance coronary angiogram and concomitant intravascular ultrasound (IVUS) imaging. After identifying a normal right coronary angiogram (Fig. 1), the clinician attempted to insert a 0.014-inch BMW (Abbott Vascular, Melno Park, CA, USA) wire for IVUS evaluation. However, resistance was quickly met, and the wire failed to pass through the proximal portion of the right coronary artery (RCA). A subsequent angiogram revealed a spiral luminal filling defect from the proximal to the distal RCA indicating coronary dissection and Thrombolysis in Myocardial Infarction (TIMI) 2 flow (Fig. 1). The ST segment elevation appeared in lead II and III on electrocardiography (ECG) monitoring, while hemodynamic parameters were stable. Urgent bailout stenting was performed: the RCA was engaged with 8 Fr guiding catheter (JR 4.0, Cordis, Bridgewater, NJ, USA); a BMW wire was inserted using a 1.8 Fr Finecross (Terumo Medical, Tokyo, Japan) micro-guiding catheter; the true lumen was confirmed by IVUS-virtual histology; and three ZES stents (Resolute Integrity 2.75×30 mm, 3.0×38 mm, 3.5×30 mm, Medtronic, Santa Rosa, CA, USA) were deployed in order from distal to proximal at 12, 16, and 16 atm, respectively, with overlap between adjacent stents. Although the right ventricular branches were compromised, final RCA angiography showed optimal angiographic results with TIMI 3 flow; ECG abnormalities eventually returned to baseline.


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

Lee PH, Lee SW, Lee JY, Kim YH, Lee CW, Park DW, Park SW, Park SJ - Korean Circ J (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310982&req=5

Figure 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.
Mentions: A 62-year-old man, who had undergone cardiac transplantation for advanced heart failure, was referred to our catheterization laboratory for a regular surveillance coronary angiogram and concomitant intravascular ultrasound (IVUS) imaging. After identifying a normal right coronary angiogram (Fig. 1), the clinician attempted to insert a 0.014-inch BMW (Abbott Vascular, Melno Park, CA, USA) wire for IVUS evaluation. However, resistance was quickly met, and the wire failed to pass through the proximal portion of the right coronary artery (RCA). A subsequent angiogram revealed a spiral luminal filling defect from the proximal to the distal RCA indicating coronary dissection and Thrombolysis in Myocardial Infarction (TIMI) 2 flow (Fig. 1). The ST segment elevation appeared in lead II and III on electrocardiography (ECG) monitoring, while hemodynamic parameters were stable. Urgent bailout stenting was performed: the RCA was engaged with 8 Fr guiding catheter (JR 4.0, Cordis, Bridgewater, NJ, USA); a BMW wire was inserted using a 1.8 Fr Finecross (Terumo Medical, Tokyo, Japan) micro-guiding catheter; the true lumen was confirmed by IVUS-virtual histology; and three ZES stents (Resolute Integrity 2.75×30 mm, 3.0×38 mm, 3.5×30 mm, Medtronic, Santa Rosa, CA, USA) were deployed in order from distal to proximal at 12, 16, and 16 atm, respectively, with overlap between adjacent stents. Although the right ventricular branches were compromised, final RCA angiography showed optimal angiographic results with TIMI 3 flow; ECG abnormalities eventually returned to baseline.

Bottom Line: Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus