The incidence and clinical impact of stent strut fractures developed after drug-eluting stent implantation

Chung, Wook Sung; Park, Chul Soo; Seung, Ki Bae; Kim, Pum Joon; Lee, Jong Min; Koo, Bon Kwon; Jang, Yang Soo; Yang, Joo Young; Yoon, Jung Han; Kim, Doo Il; Yoon, Young Won; Park, Jong Seon; Cho, Yoon Haeng; Park, Seung Jung

doi:10.1016/j.ijcard.2007.02.033

Cited by 77 publications

(76 citation statements)

References 15 publications

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“…6,[8][9][10]21 In the present study, ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF after EES implantation. Among these, hinge motion and tortuosity contributed most greatly to the incidence of SF.…”

Section: Discussionsupporting

confidence: 48%

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Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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Background-Stent fracture (SF) after drug-eluting stent implantation has recently become an important concern because of its potential association with in-stent restenosis and stent thrombosis. However, the incidence and clinical impact of SF after everolimus-eluting stent implantation remain unclear. Methods and Results-A total of 1035 patients with 1339 lesions undergoing everolimus-eluting stent implantation and follow-up angiography 6 to 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy or intravascular ultrasound during follow-up. We assessed the rates of SF and major adverse cardiac events, defined as cardiac death, myocardial infarction, stent thrombosis, and clinically driven target lesion revascularization within 9 months. SF was observed in 39 of 1339 lesions (2.9%) and in 39 of 1035 patients (3.8%). Ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF. The rate of myocardial infarction and target lesion revascularization were significantly higher in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018 and 25.6% versus 2.0%; P<0.001, respectively). Stent thrombosis was more frequently observed in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018). Major adverse cardiac events within 9 months were significantly higher in the SF group than in the non-SF group (25.6% versus 2.3%; P<0.001). Conclusions-SF after everolimus-eluting stent implantation occurs in 2.9% of lesions and is associated with higher rate of major adverse cardiac events, driven by higher target lesion revascularization and stent thrombosis. (Circ Cardiovasc Interv. 2012;5:663-671.)

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Section: Discussionsupporting

confidence: 48%

“…18,21 Several studies have demonstrated that SES is more likely to cause SF because of its closed-cell design and because of being made of stainless steel with low flexibility and conformability. 22 The EES is a new-generation DES and features a thin-strut, flexible, cobalt-chromium platform, 23 which is expected to prevent SF.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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“…14,23) Several studies have demonstrated that sirolimus-eluting stents are more likely to cause SF because of the closed-cell design and the stainless steel material with low flexibility and conformability. 24) Furthermore, it has been reported that overlap stenting and longer stent length are associated with SF.…”

Section: Discussionmentioning

confidence: 99%

Impact of Coronary Stent Fracture on Restenotic Neointimal Tissue Characterization After Drug-Eluting Stent Implantation

et al. 2017

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SummaryAlthough drug-eluting stents (DESs) reduce the rates of in-stent restenosis (ISR) and subsequent target lesion revascularization, stent fracture (SF) after DES implantation has become an important concern because of its potential association with restenosis and stent thrombosis. We aimed to assess the pathogenic impact of SF on in-stent restenotic neointimal tissue components after DES implantation. We analyzed 43 consecutive patients (14 with SF and 29 without SF) with ISR requiring revascularization after DES implantation between January 2008 and March 2014. For evaluation of in-stent tissue components, integrated backscatter intravascular ultrasound (IB-IVUS) was performed. SF was defined as complete or partial separation of stent segments observed using plain fluoroscopy or intravascular ultrasound. On volumetric IB-IVUS analyses, patients with SF had a significantly higher percentage of lipid tissue volume within the neointima and a significantly lower percentage of fibrous tissue volume than those without (37.3 ± 18.9% versus 24.9 ± 12.4%, P = 0.02, and 61.2 ± 18.3 versus 72.6 ± 12.1%, P = 0.04, respectively). Moreover, SF was positively correlated with the percentage of lipid volume on multiple linear regression analysis after adjustment for confounding factors (β = 0.36, P = 0.03). The interval from stent implantation was similar in both groups (47.0 ± 28.7 versus 37.7 ± 33.3 months; P = 0.39). In conclusion, SF is associated with larger lipid tissue volume within the neointima after DES placement, suggesting a contribution to the development of neoatherosclerosis and vulnerable neointima. Thus SF might lead to future adverse coronary events.(Int Heart J 2017; 58: 861-867)

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“…The proportion of in-stent restenosis related to stent fracture has been reported as 65%, but without acute coronary syndrome. 3 Stent fracture may represent a new potential mechanism of restenosis with DES. 4,5 Local under-dosage because of DES fracture, in combination with increased mechanical irritation, are the most probable cause of focal restenosis.…”

Section: Discussionmentioning

confidence: 99%

Very Late Stent Thrombosis Associated With Multiple Stent Fractures and Peri-Stent Aneurysm Formation After Sirolimus-Eluting Stent Implantation

Lee

Lim

et al. 2008

Circ J

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revious randomized trials have shown that drugeluting stents (DES) are superior to bare-metal stents (BMS) in reducing the need for target lesion revascularization, but safety issues with DES have recently been raised. Case ReportIn February 2004, a 64-year-old man underwent percutaneous coronary intervention (PCI) for total occlusion of the proximal left anterior descending artery (LAD) using a 3.5×20 mm Tsunami stent™ (Terumo, Tokyo, Japan) under the diagnosis of subacute myocardial infarction. Routine follow-up coronary angiography at 6 months after PCI showed no in-stent restenosis, but there was significant stenosis of the mid-LAD bifurcation portion, so we deployed a 3.0× 33 mm Cypher stent™ (Cordis, Johnson & Johnson, New Brunswick, NJ, USA) inflated to 14 atm. Afterwards, the 2 nd diagonal branch (D2) of the LAD was compromised, so we dilated the lesion using a kissing balloon technique. Final coronary angiography showed no residual stenosis. That night, the patient suffered sudden severe anterior chest pain and the electrocardiogram (ECG) showed new T-wave inversion and ST-segment depression in the V3-6 leads. Emergency coronary angiography showed that the distal flow was good and the stent in the mid-LAD was patent, but D2 was compromised because of dissection. We deployed a 2.5×23 mm Cypher stent™ at 14 atm for D2, and then ballooned into the LAD with a reversed crush technique using a 3.0-mm balloon catheter. We performed a final kissing balloon dilation for the LAD and D2 (Fig 1). In March, 2005, repeat follow-up coronary angiography showed no in-stent restenosis, but there was mild peri-stent aneurysm Circulation Journal Vol.72, July 2008 formation in the mid-LAD. The patient had no cardiac symptoms during clinical follow-up after the second followup angiogram, and medical treatment was continued with aspirin 200 mg/day, a -blocker and a statin. In June 2007, the patient was admitted with gall stones and intestinal ileus. During treatment he stopped taking aspirin for 3 days and the next day, 35 months after Cypher™ stenting, he was taken to the emergency room because of severe squeezing chest pain for 1 h; the ECG showed tall T wave in the anterior wall (ie, regional wall motion abnormality) (Fig 2). The levels of cardiac enzymes were within the normal ranges [creatine kinase (CK): 36 U/L, CK-MB: 0.3 ng/ml, troponin I: 0.0 ng/ml]. Urgent coronary angiography revealed a patent BMS in the proximal LAD, but the sirolimus-eluting stents (SES) in the mid-LAD and D2 were totally occluded by massive thrombosis. Peri-stent aneurysmal dilation and 5-segment stent strut fractures were noted ( Figs 3A,B). We tried to cross the occlusion site using a guidewire, but were prevented by the severe displacement of the stent fracture Circ J 2008; 72: 1201 -1204 (Received September 19, 2007 revised manuscript received November 14, 2007; accepted December 11, 2007

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The incidence and clinical impact of stent strut fractures developed after drug-eluting stent implantation

Cited by 77 publications

References 15 publications

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Impact of Coronary Stent Fracture on Restenotic Neointimal Tissue Characterization After Drug-Eluting Stent Implantation

Very Late Stent Thrombosis Associated With Multiple Stent Fractures and Peri-Stent Aneurysm Formation After Sirolimus-Eluting Stent Implantation

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