Incidence of coronary drug-eluting stent fracture: A systematic review and meta-analysis

Abstract

BackgroundReported evidence of coronary stent fracture (CSF) has increased in recent years. The purpose of this study was to determine reliable estimates of the overall incidence of CSF.Methods and resultsThe MEDLINE, Embase and Cochrane databases were searched until March 18, 2022. Pooled estimates were acquired using random effects models. Meta-regression and subgroup analysis were used to explore sources of heterogeneity, and publication bias was evaluated by visual assessment of funnel plots and Egger’s test. Overall, 46 articles were included in this study. Estimates of CSF incidence were 5.5% [95% confidence interval (CI): 3.7–7.7%] among 39,953 patients based on 36 studies, 4.8% (95% CI: 3.1–6.8%) among 39,945 lesions based on 29 studies and 4.9% (95% CI: 2.5–9.4%) among 19,252 stents based on 8 studies. There has been an obvious increase in the incidence of CSF over the past two decades, and it seems that the duration of stent placement after stent implantation has no impact on incidence estimation.ConclusionThe incidence of CSF was 5.5% among patients, 4.8% for lesions and 4.9% for stents and increased over the past 20 years. The duration of stent placement after stent implantation was found to have no impact on the incidence of CSF, but drug-eluting stent (DES) types and right coronary artery (RCA) lesions influenced the pooled incidence.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022311995], identifier [CRD42022311995].

A case of repeated stent fracture

“…Its incidence is estimated to be 1%–30%, and while DES fractures with little or no lumen narrowing can pass asymptomatically, they can cause inadequate drug delivery and in-stent restenosis, in addition to other consequences such as stent thrombosis, acute coronary syndromes including ST-elevation myocardial infarction, and even aneurysm formation [ 3 , 4 ]. The incidence of stent fracture in clinical practice has increased significantly in recent years due to the development of stents with thinner steels and the widespread use of intraluminal imaging technology [ 5 ]. Risk factors for stent fracture include longer stent length, overlapping stent edges, angulated and calcified lesions, sirolimus-eluting stents, right coronary artery lesions, saphenous vein lesions and aggressive dilatation [ 1 , 3 , 6 ].…”

Numerical Simulation of Dynamic Degradation and Fatigue Damage of Degradable Zinc Alloy Stents

“…The damage value with time is shown in Equation (12). The selection of fatigue damage stress values is the same as the selection of stress corrosion stress values.…”

“…The stent fracture is mainly due to the fatigue of the stent itself. The probability of stent fracture after stent implantation ranges from 3.7% to 7.7% [12]. Stent fracture increases the probability of thrombus formation within the stent, thereby increasing the fatal risk for patients.…”