Stent Fracture in the Coronary and Peripheral Arteries

Abstract

Inherent risks of stenting include restenosis and thrombosis. Recently, stent fractures have been recognized as a complication that may result in thrombosis, perforation, restenosis, and migration of the stent resulting in morbidity and mortality. Stent fractures were originally seen in the superficial femoral arteries but have since then been reported in almost all vascular sites including the coronary, renal, carotid, iliac, and femoropopliteal arteries. Fractures are the result of the complex interplay between stent manufacturing, the stented segment, pulsatile and nonpulsatile biomechanical forces, and plaque morphology at a particular vascular site. The presentation of a patient with a fracture is highly variable, ranging from asymptomatic in nature, detected on routine screening without any sequelae, to sudden cardiac death related to a thrombosed coronary artery. Despite being recognized as an important complication, consensus on routine surveillance and diagnostic methods to detect fractures continues to be lacking. Fortunately, most cases are relatively benign and can be managed conservatively if detected. In the setting of recurrent symptoms, further intervention is usually sought. In review of the literature most cases are managed with placement of a stent over the fractured area, the stent-in-stent technique, but several other alternatives may be available. As the knowledge of the variables that make stents prone to fracture are identified, better technologies and techniques can be employed to minimize the risk of this complication. This article reviews the available literature on stent fractures and complications using data found on PubMed, MEDLINE, the Manufacturer and User Facility Device Experience (MAUDE) database, and the Cochrane databases.

Calcium Burden Assessment and Impact on Drug-Eluting Balloons in Peripheral Arterial Disease

“…Technical success and patency rates are reported to be lower in case of very calcified arteries [1,[5][6][7].…”

“…Moreover, it increases the occurrence of flow limiting dissections after PTA [8] and acute vessel recoil, with consequent increased use of stents. Also, in this condition calcium persists in playing an unfavourable role by increasing the risk of stent subexpansion, malposition, and fractures as shown in the coronary environment [5][6][7][8][9].…”

Disintegration of a Balloon-Expandable Stent in the Iliac Artery Upon Delivery

“…All stents may be exposed to as many as 10 (8) cyclic systolic/ diastolic loads over a designed lifetime of 10 years. This persistent pulsatile loading may result in propagation of these microcracks (12). In our case disintegration of the balloon-expandable stent might be occurred through the similar pathway.…”

Shannon Entropy-Based Wavelet Transform Method for Autonomous Coherent Structure Identification in Fluid Flow Field Data

“…The implantation of a realistic "SX-type" stent model as described by Hanus and Zahora [24] led to the observation of transitional secondary structures over those previously reported by Dean [25,26], Lyne [27], Sudo et al [28], Boiron et al [29], Timité et al [30] and Glenn et al [22]. Stent fractures (SFs) may be associated with unanticipated late complications, including clinical in-stent restenosis (ISR), stent thrombosis and aneurysm formation [31][32][33][34][35]. "Type IV" stent fractures have been defined by Jaff et al [36] as a complete transverse, linear fracture of stent struts along with displacement of the stent fragments.…”