In the stent era, in addition to restenosis, there are many important consequences deserving more attention. Firstly described in peripheral vascular interventions, it took several years for stent fracture to be known as an appreciable complication of coronary intervention. Especially with the introduction of drug eluting stents and the use of coronary stents in more complex cases, its prevalence has raised and new data have been published concerning its mechanism, predictors, diagnosis, clinical course and treatments. This review will discuss the available literature about stent fracture.

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We performed a randomized controlled trial to test the potential benefits of fluoroscopic-guided femoral artery puncture. Observational studies showed a consistent relationship between common femoral artery (CFA) and the head of femur. Fluoroscopy locating the femoral head may increase the accuracy of femoral puncture and consequently decrease the vascular complication. Despite these theoretical benefits, we have no sufficient evidence to verify its advantages. Patients undergoing diagnostic cardiac catheterization were randomized into fluoroscopic and anatomic method groups. Of total of 609 patients participated in this study, 305 and 304 patients were assigned to fluoroscopic and anatomic method groups, respectively. Fluoroscopy significantly increases the puncture over the femoral head (96.7 vs. 82.3 %, p value 0.001) and also the fluoroscopic method increased CFA puncture significantly (93.8 vs. 87.5 %, p value 0.012). The combined end point of “proper” femoral puncture (CFA puncture over the femoral head) was highly significant in our fluoroscopy-guided method (91.8 vs. 75.7 %, p value <0.0001). Hematoma was the only vascular complication trough the study (2.6 % of patients) but no significant difference was seen between the two groups. In conclusion, our study showed the efficacy of fluoroscopy in increasing the proper femoral artery puncture, and although it did not show significant improvement in vascular complications, the method should be regard as an accurate guide for femoral access.

A septal branch playing the role of a right coronary artery A 56-year-old woman was hospitalised in our emergency department with a new onset chest pain and exertional dyspnoea. Her pain had started 3 weeks earlier and its severity had apparently aggravated. She reported to have an elevated blood pressure during the last 5 years which was controlled by Captopril 25 mg three times a day. At physical exam, her blood pressure was 135/95 mm Hg, and her heart rate and respiratory rate were 65 bpm and 15, respectively. Her cardiac exam was quite normal. Her ECG, showed a 0.05 mV ST depression on the inferior leads. She had a normal left ventricular ejection fraction on her echocardiography, and apart from a mild hypokinesia of the inferior wall, no other abnormality was reported. She had undergone an electrographic exercise stress test which was positive. She was a candidate for coronary angiography. At the left injection, a long septal branch was first noted. Subsequent views showed that the artery deviated from its usual course and ran to the right side and supplied the right coronary artery (RCA) territory (figure 1A and online supplementary movies I and II). Surprisingly, the right cusp was empty and no RCA was detected (figure 1B). Coronary anomalies occurred in 1-5% of general population and the incidence of ectopic RCA is about 0.92%.1 We presented a rare form of coronary artery anomaly, which to our knowledge had never been reported. In the present case, the septal branch artery from the left anterior descending artery plays the role of RCA.

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