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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

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.
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Figure 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.

Mentions: A 75-year-old man was admitted with a history of effort-related chest pain persisting for two years. Prior to being admitted, his chest pain increased in intensity and frequency despite taking appropriate medications. The patient had a 10-year documented history of hypertension and was an ex-smoker. An ECG showed a left ventricular hypertrophy pattern without ST segment change. A Thallium-201 myocardial perfusion scan showed severe reduction of tracer uptake in the septum and anterior walls. Coronary angiography revealed diffuse eccentric stenosis in the left anterior descending artery (LAD) (Fig. 2). A minimally invasive direct bypass surgery was planned because the lesion was long, originated from the ostium of the LAD, and was accompanied by very heavy calcification: this indicated that the patient was not suitable for coronary intervention. However, the patient also had comorbid psychological issues including anxiety disorder and claustrophobia, which were not ameliorated by professional psychotherapy; the patient strongly refused surgery. Considering the patient's extant physical and psychological issues, coronary intervention was a suboptimal option for him.


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)

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

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

Figure 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.
Mentions: A 75-year-old man was admitted with a history of effort-related chest pain persisting for two years. Prior to being admitted, his chest pain increased in intensity and frequency despite taking appropriate medications. The patient had a 10-year documented history of hypertension and was an ex-smoker. An ECG showed a left ventricular hypertrophy pattern without ST segment change. A Thallium-201 myocardial perfusion scan showed severe reduction of tracer uptake in the septum and anterior walls. Coronary angiography revealed diffuse eccentric stenosis in the left anterior descending artery (LAD) (Fig. 2). A minimally invasive direct bypass surgery was planned because the lesion was long, originated from the ostium of the LAD, and was accompanied by very heavy calcification: this indicated that the patient was not suitable for coronary intervention. However, the patient also had comorbid psychological issues including anxiety disorder and claustrophobia, which were not ameliorated by professional psychotherapy; the patient strongly refused surgery. Considering the patient's extant physical and psychological issues, coronary intervention was a suboptimal option for him.

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