Serial angiographic and intravascular ultrasound analysis of late stent strut fracture of sirolimus-eluting stents in native coronary arteries

Late asymptomatic sirolimus-eluting stent fracture in a female with systemic lupus erythematosus

“…The exact impact -if any -of new generation X-ray equipment with flat-panel fluoroscopic techniques and stent boost is not clear. IVUS seems to facilitate SF detection by revealing disrupted or absence of stent struts, loss of struts architecture, intimal hyperplasia and focal restenosis [4]. OCT is an evolving imaging technique with much higher spatial resolution compared to IVUS, although limited to the inner vessel wall.…”

The use of intra-coronary optical coherence tomography for the assessment of sirolimus-eluting stent fracture

“…Although uncommon, stent fracture is increasingly being reported in the literature and, in the DES era, is more often associated with SES [3][4][5][6][7]. In a recent study of 530 patients who received DES with follow-up angiography, Lee et al [2] identified stent fracture in 10 (1.9%) patients, all restricted to those with SES.…”

“…Recently however, Yamada et al [7] demonstrated the limitations of angiography by studying 102 consecutive patients receiving SES. Angiography failed to detect any cases of stent fracture at 6 months whereas intravascular ultrasound (IVUS) identified 3 cases.…”

Assessment of drug-eluting stents and bioresorbable stents by grayscale IVUS and IVUS-based imaging modalities

“…According to the authors of this study, high magnification cine-angiography is the best method to diagnose stent fracture and, although intravascular ultrasound was performed in 10 out of the 35 cases of stent fracture, it did not add any value to high magnification cine-angiography [32]. However, in a most recent article studying 83 lesions in 56 patients by serial angiography and IVUS at baseline and at 6 months follow-up, Yamada et al found that at 6 months by angiography no cases of stent fracture were detected, while by IVUS 3 cases were detected [33]. Moreover, IVUS is not only helpful to identify stent fracture as cause of stent failure, but more importantly to understand possible mechanisms of stent fractures, such as aneurysm formation [34].…”