Classification and Potential Mechanisms of Intravascular Ultrasound Patterns of Stent Fracture

Doi, Hiroshi; Maehara, Akiko; Mintz, Gary S.; Tsujita, Kenichi; Kubo, Takashi; Castellanos, Celia; Liu, Jian; Yang, Jian; Oviedo, Carlos; Aoki, Jiro; Franklin-Bond, Theresa; Dasgupta, Neil; Lansky, Alexandra J.; Dangas, George; Stone, Gregg W.; Moses, Jeffrey W.; Mehran, Roxana; Leon, Martin B.

doi:10.1016/j.amjcard.2008.11.051

Cited by 94 publications

(79 citation statements)

References 25 publications

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“…It might be because poorer endothelialization or positive vessel remodeling occurs at stent fracture site and leads to VLST occurrence continually. 7,28, 29 The present data reflect the fact that stent fracture is one of the important factors in VLST occurrence after DES implantation. Therefore, DES implantation might be avoided in the type of lesions which was reported to be associated with stent fracture.…”

Section: Discussionmentioning

confidence: 72%

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Kubo

Kadota

Ozaki

et al. 2013

Circ J

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Background: Limited data are available with which to compare the clinical characteristics of patients with very late stent thrombosis (VLST) after drug-eluting stent (DES) or bare-metal stent (BMS) implantation. The purpose of this study was to investigate the differences in the characteristics of VLST after DES and BMS implantation by reviewing the clinical and angiographic data. Methods and Results:A total of 28 patients (30 lesions) with VLST after DES implantation and 33 patients (33 lesions) with VLST after BMS implantation were identified. The occurrence of VLST after BMS implantation (2,647±996 days) was much later than that after DES implantation (1,194±558 days, P<0.001). The number of VLST after DES implantation increased gradually each year; however VLST after BMS implantation started to occur >50 months later, and its number increased subsequently. The prevalence of VLST related to surgical procedures involving discontinuation of antiplatelet therapy in VLST patients was higher after DES implantation (14.3%) than after BMS implantation (0%, P=0.039). Angiographic stent fracture was seen in 36.7% of VLST lesions after DES implantation at different times (464-2,102 days after procedure), while none was seen in VLST lesions after BMS implantation (P<0.001). Conclusions:The timing of VLST was different after DES and BMS implantation. Stent fracture was a specific finding of VLST after DES implantation. (Circ J 2013; 77: 1453 -1460

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Section: Discussionmentioning

confidence: 72%

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Kubo

Kadota

Ozaki

et al. 2013

Circ J

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“…It is recommended to select stent diameter which allows for expansion to the reference diameter of the proximal main vessel, this can be possible with overexpansion of the stent by large balloons [20]. But, overexpansion may lead to stent fracture which carries thrombosis risk [2,7,21]. Maximal diameter of most available DESs in the market is 4.0 mm and the manufacturers do not recommend dilating these stents more than 4.5 mm, because of the risk of incomplete sent apposition, plaque prolapse, impaired drug delivery, and strain and dissection of the arterial tissue [9].…”

Section: Discussionmentioning

confidence: 99%

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

et al. 2017

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“…Complete fractures like type 3 or 4 SFs are risk factors for CAA, like in the case of our patient, although the incidence is quite low. 9,10) CAA is defined as artery dilatation exceeding 50% of the reference vessel diameter; CAA has multiple etiologies and the prevalence ranges from 0.3% to 4.5%. 6,15) Atherosclerotic disease is the major cause of CAA, apart from autoimmune responses, such as Kawasaki disease and Behcet's disease, and connective tissue disorders, such as Ehlers-Danlos disease and Marfan syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…1) SF can be classified into several types, and complete and severe fracture types rarely lead to coronary artery aneurysm (CAA). 9,10) Thus far, the established treatment and management for CAAs with SF are unclear.…”

mentioning

confidence: 99%

Coronary Artery Aneurysm Caused by a Stent Fracture

et al. 2018

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SummaryCoronary stent fracture (SF) is rare as a complication of percutaneous coronary intervention (PCI), and its adverse events are increasingly being recognized with the development in devices of PCI. The major adverse events caused by SFs are in-stent restenosis due to neointimal overgrowth caused by poor drug delivery.1,2) A coronary artery aneurysm (CAA) is a rare complication of SF, but may lead to lethal events such as acute coronary syndrome or rupture of the CAA further leading to cardiac tamponade. [3][4][5] However, the management of CAAs is controversial with or without SF.6) Herein, we report a case of a CAA caused by an SF and discuss the management of CAA complicated with SF, along with a literature review. We suggest that surgical treatment should be considered the higher-priority strategy in the cases of CAA with SF as compared to CAA without SF.(Int Heart J 2018; 59: 203-208) Key words: Coronary artery disease, Drug-eluting stent, In-stent restenosis A lthough the use of drug-eluting stents (DESs) has significantly improved its long-term outcomes after percutaneous coronary intervention (PCI), instent restenosis (ISR) still occurs in some cases and target vascular revascularization is required. 7,8) Coronary stent fracture (SF) is increasingly being recognized as one of the causes of ISR.1) SF can be classified into several types, and complete and severe fracture types rarely lead to coronary artery aneurysm (CAA).9,10) Thus far, the established treatment and management for CAAs with SF are unclear. Case ReportA 69-year-old man with multiple coronary risk factors, including hypertension, hyperlipidemia, type-2 diabetes mellitus, smoking history, and chronic kidney disease, presented to our hospital for a follow-up coronary angiography (CAG) 6 months after PCI. He had undergone CAG and PCI several times as described below.In 2003, an electrocardiogram showed ST segment depression, and a cardiac exercise stress test and radioisotope revealed ischemic changes in the anterior and inferior segments of the left ventricle; therefore, CAG was performed for the first time. CAG demonstrated 90% stenosis in the proximal right coronary artery (RCA) and 75% stenosis in the proximal left anterior descending artery (LAD) with mild stenosis in the left circumflex artery (LCX). PCI was successfully performed, and bare-metal stents (BMSs; 4.0 × 13 mm and 3.5 × 20 mm) were implanted in the ostium of the RCA and proximal LAD, respectively. Six months later, in 2004, a follow-up CAG revealed no in-stent restenosis (ISR), and dual antiplatelet therapy (DAPT) was changed to single antiplatelet therapy (SAPT). In 2014, the patient was diagnosed with earlystage gastric cancer, and CAG was performed before the gastric cancer surgery. CAG revealed ISR in the RCA and progression of the stenosis in the LCX. A week before the surgery, SAPT was changed to heparin, and DAPT was started after it. Following the surgery, PCI was performed and a zotarolimus-eluting stent (Resolute Integlity 2.5 × 22 mm) was implanted in the LCX,...

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Classification and Potential Mechanisms of Intravascular Ultrasound Patterns of Stent Fracture

Cited by 94 publications

References 25 publications

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

Coronary Artery Aneurysm Caused by a Stent Fracture

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