Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: Comparison with initial platform of sirolimus-eluting stent

Abstract

Although implantation of the newer DES platforms might reduce the occurrence of SF compared with the CBX, SF-related binary restenosis and TLR remain similarly high. And to predict SF in the newer DES platforms' era, lesion characteristics on index procedure are more important than implanted stent design.

Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database

“…Similarly, the most common modality of presentation for SF cases in either first generation or contemporary platforms in our analysis was in‐stent restenosis or stent thrombosis accounting for 50–60% of cases which is similar to the 30–60% restenosis rates reported in cypher and second generation SF cases in previous reports . Analysis by micro‐CT in pathological specimens show evidences of the impact of SFs of inflammation and restenosis with both first and second generation DES .…”

“…Our data suggests that there are many features common to SF cases that are shared by both contemporary and first generation platforms, such as the complexity of disease that predispose to SF including tortuous and calcified lesions as well as anatomical sites of occurrence, particularly in the right coronary artery and in overlapping stents. Indeed previous analyses have shown that tortuous and complex lesions are more commonly associated with SF and stent overlap whilst stent length and significant lesion angulation were independent predictors of SF .…”

Structural Mechanics Predictions Relating to Clinical Coronary Stent Fracture in a 5 Year Period in FDA MAUDE Database

“…In concert with previous reports, 37,38 DES fractures more often involved Cypher stents (Cordis™, Johnson & Johnson, NJ, USA), though the bare metal backbone Bx Velocity stent (Cordis™, Johnson & Johnson, NJ, USA) had fracture occurrence on par with other BMS designs (Supplementary Table 1). Differences in stent diameter were trivial between the two patient groups (Table 1); however, patients with stent fracture had longer stents.…”

Coronary Stent Fracture: A Recently Appreciated Phenomenon with Clinical Relevance

“…Although there have been a few reports showing no specific predilection for the location of stent fracture [1], the right coronary artery (RCA) appears to be favoured [1, 5, 18, 29, 30]. In a meta-analysis on stent fracture, the incidence rates of this complication in the RCA, left anterior descending artery (LAD), left circumflex artery (LCX), SVG, and left main artery were 56.4%, 30.4%, 10.9%, 1.7%, and smaller than 0.01%, respectively [5].…”

“…Elsewhere, after a multivariate analysis, Park et al . found that stent length, use of the SES, minimum stent diameter, and maximal inflation pressure were the only significant predictors of stent fracture [30]. And finally, Kuramitsu et al .…”