Coronary-Stent Fracture

Chowdhury, Pertha S.; Ramos, Renato G.

doi:10.1056/nejmicm020259

Cited by 73 publications

(19 citation statements)

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“…It has been speculated that stent strut overstretching and mechanical stress, such as repetitive kinking of the stent body, during the cardiac cycle may play a role in the occurrence of stent fracture, because stent fracture in the right coronary artery or saphenous vein grafts has been frequently reported. [12][13][14][15]26 In our study, 1 lesion was located in the right coronary artery, 2 in the circumflex coronary artery and 1 in the left anterior descending coronary artery.…”

Section: Incidence and Possible Mechanism Of Stent Fracturementioning

confidence: 99%

Restenosis and Stent Fracture Following Sirolimus-Eluting Stent (SES) Implantation A Serial Quantitative Coronary Angiography (QCA) and Intravascular Ultrasound (IVUS) Study

Okumura

Ozaki

Ishii

et al. 2007

Circ J

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ollowing the development of drug-eluting stents (DES) the interventional cardiologist seems to have overcome the nemesis of restenosis. The First-InMan study and a randomized comparison of a sirolimuseluting stent (SES) with a standard stent for coronary revascularization reported complete inhibition of restenosis in simple discrete lesions at 6 months. 1,2 However, recent randomized clinical trials using DES for lesions with lowor intermediate restenosis risk reported restenosis rates ranging from 2.3% to 16.7%. [3][4][5][6][7][8][9][10][11][12] Furthermore, the number of DES used and the stent length required for each lesion are both substantially increasing based on the recent recommended policy of full lesion coverage to avoid any potential injury at the stent edges. popularity of DES technologies worldwide, the precise mechanisms responsible for DES restenosis remain unclear. Several case reports have highlighted the occurrence of stent fracture (absence or deformity of a stent strut inside the stent) at follow-up, especially in patients experiencing restenosis with SES, however, the incidence of fracture and its impact on restenosis are poorly understood. [12][13][14][15][16][17][18] The purpose of this study was to investigate the predictors of restenosis following SES implantation and to determine the incidence and impact of stent fracture. We prospectively performed the SES implantation under intravascular ultrasound (IVUS) Guidance in Native coronary Artery Lesions (SIGNAL) study at the Fujita Health University hospital. Methods Study Design and EndpointsThe SIGNAL study was designed as a prospective, single-center, angiographic and IVUS follow-up study to evaluate the acute and late efficacy, as well as safety of deployment, of SES. The primary endpoint was angiographic restenosis. The principal clinical endpoint was a composite Circ J 2007; 71: 1669 -1677 (Received September 19, 2006 revised manuscript received July 5, 2007; accepted July 19, 2007 Although multivariate logistic regression analysis revealed that minimal lumen area (min-LA) post (p=0.027), total stent length (p=0.003) and diabetes (p=0.032) were significant independent predictors of restenosis, univariate analysis showed that stent fracture was more common in the restenosis than in the non-restenosis groups (p=0.001).Conclusions Although min-LA post by IVUS, total stent length by QCA and diabetes are independent predictors for angiographic restenosis, stent fracture occurred in 4 lesions (2.4%) and all of them resulted in restenosis (31% of the restenosis). The impact of stent fracture and its potential role in the development of restenosis deserves further study. (Circ J 2007; 71: 1669 -1677)

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Section: Incidence and Possible Mechanism Of Stent Fracturementioning

confidence: 99%

Restenosis and Stent Fracture Following Sirolimus-Eluting Stent (SES) Implantation A Serial Quantitative Coronary Angiography (QCA) and Intravascular Ultrasound (IVUS) Study

Okumura

Ozaki

Ishii

et al. 2007

Circ J

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“…Recent reports on device failures in the coronary, 11 carotid, 12 renal, 2,16,36,38 aorta, 4,25,26 iliac, 37 popliteal, 46 and superficial femoral arteries (SFA), 1,18,39 have been a source of great concern in the medical device industry, among physicians and for regulatory agencies, stimulating research on the characterization of in vivo arterial deformation. A lack of knowledge of the in vivo biomechanical environment may lead to devices that are designed for deformations that are arguably much less important than others.…”

Section: Introductionmentioning

confidence: 99%

Methods for Quantifying Three-Dimensional Deformation of Arteries due to Pulsatile and Nonpulsatile Forces: Implications for the Design of Stents and Stent Grafts

Choi

Cheng

Wilson³

et al. 2008

Ann Biomed Eng

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The knowledge of dynamic changes in the vascular system has become increasingly important in ensuring the safety and efficacy of endovascular devices. We developed new methods for quantifying in vivo three-dimensional (3D) arterial deformation due to pulsatile and nonpulsatile forces. A two-dimensional threshold segmentation technique combined with a level set method enabled calculation of the consistent centroid of the cross-sectional vessel lumen, whereas an optimal Fourier smoothing technique was developed to eliminate spurious irregularities of the centerline connecting the centroids. Longitudinal strain and novel metrics for axial twist and curvature change were utilized to characterize 3D deformations of the abdominal aorta, common iliac artery, and superficial femoral artery (SFA) due to musculoskeletal motion and deformations of the coronary artery due to cardiac pulsatile motion. These illustrative applications show the significance of each deformation metric, revealing significant longitudinal strain and axial twist in the SFA and coronary artery, and pronounced changes in vessel curvature in the coronary artery and in the inferior region of the SFA. The proposed methods may aid in designing preclinical tests aimed at replicating dynamic in vivo conditions in the arterial tree for the purpose of developing more durable endovascular devices including stents and stent grafts.

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“…SES fracture has been recently reported [1][2][3][4]. To the best of our knowledge, this is the first case report of complete SES fracture detected by multislice CT.…”

Section: Discussionmentioning

confidence: 65%

Complete fracture of sirolimus-eluting stent detected by multislice computed tomography

Zaizen

Tamura

Miyamoto

et al. 2007

International Journal of Cardiology

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Coronary-Stent Fracture

Cited by 73 publications

References 0 publications

Restenosis and Stent Fracture Following Sirolimus-Eluting Stent (SES) Implantation A Serial Quantitative Coronary Angiography (QCA) and Intravascular Ultrasound (IVUS) Study

Restenosis and Stent Fracture Following Sirolimus-Eluting Stent (SES) Implantation A Serial Quantitative Coronary Angiography (QCA) and Intravascular Ultrasound (IVUS) Study

Methods for Quantifying Three-Dimensional Deformation of Arteries due to Pulsatile and Nonpulsatile Forces: Implications for the Design of Stents and Stent Grafts

Complete fracture of sirolimus-eluting stent detected by multislice computed tomography

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