Clinical outcomes and optimal treatment for stent fracture after drug-eluting stent implantation

Lee, Shin Eun; Jeong, Myung Ho; Kim, In Soo; Ko, Jum Suk; Lee, Min Goo; Kang, Won Yu; Kim, Soo Hyun; Sim, Doo Sun; Park, Keun Ho; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

doi:10.1016/j.jjcc.2009.02.010

Cited by 43 publications

(57 citation statements)

References 10 publications

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“…Although it was statistically difficult to compare them with EES, these results were consistent with previous studies. 6,18,24 SF has been associated with higher potential risks of ISR, TLR, and ST. 5 The mechanisms of ISR in SF are probably related to the lower drug delivery at the fracture site and higher mechanical irritation by the fractured struts, causing smooth by guest on May 12, 2018 http://circinterventions.ahajournals.org/ Downloaded from muscle cell proliferation and impaired re-endothelialization. In the present study, the rates of clinically driven TLR and MACE were significantly higher in lesions with SF than in those without SF.…”

Section: Discussionmentioning

confidence: 99%

“…Particular concerns have been raised about the risks of DES, especially stent thrombosis (ST). 3,4 Stent fracture (SF) after DES implantation has recently become an important concern because of its potential association with ISR, TLR, and ST. 5 SF after sirolimus-eluting stent (SES) implantation has been reported to be associated with an increased risk of ISR, ranging from 15% to 60%, and with higher cardiac event rates within a 1-year observation period. [6][7][8][9][10][11] A recently published pathological study of 144 autopsy cases with DES implantation detected SF in 29% of lesions, and SFs with gaps within the stent body were associated with histological events, such as ST or restenosis, in 67% of cases.…”

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confidence: 99%

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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: Discussionmentioning

confidence: 99%

mentioning

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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“…With regard to the management strategy, surgical treatment and PCI were performed in 8 cases, and 4 cases were managed with observation and triple antiplatelet therapy. Among the cases where surgery was performed, CABG was performed in 8 patients along with the following additional procedures in some cases: stent removal (3), aneurysm ligation (1), aneurysm removal (1), and no mention of additional procedures (2). Debridement with stent removal without CABG was performed in 1 case.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Aneurysm Caused by a Stent Fracture

et al. 2018

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SummaryCoronary stent fracture (SF) is rare as a complication of percutaneous coronary intervention (PCI), and its adverse events are increasingly being recognized with the development in devices of PCI. The major adverse events caused by SFs are in-stent restenosis due to neointimal overgrowth caused by poor drug delivery.1,2) A coronary artery aneurysm (CAA) is a rare complication of SF, but may lead to lethal events such as acute coronary syndrome or rupture of the CAA further leading to cardiac tamponade. [3][4][5] However, the management of CAAs is controversial with or without SF.6) Herein, we report a case of a CAA caused by an SF and discuss the management of CAA complicated with SF, along with a literature review. We suggest that surgical treatment should be considered the higher-priority strategy in the cases of CAA with SF as compared to CAA without SF.(Int Heart J 2018; 59: 203-208) Key words: Coronary artery disease, Drug-eluting stent, In-stent restenosis A lthough the use of drug-eluting stents (DESs) has significantly improved its long-term outcomes after percutaneous coronary intervention (PCI), instent restenosis (ISR) still occurs in some cases and target vascular revascularization is required. 7,8) Coronary stent fracture (SF) is increasingly being recognized as one of the causes of ISR.1) SF can be classified into several types, and complete and severe fracture types rarely lead to coronary artery aneurysm (CAA).9,10) Thus far, the established treatment and management for CAAs with SF are unclear. Case ReportA 69-year-old man with multiple coronary risk factors, including hypertension, hyperlipidemia, type-2 diabetes mellitus, smoking history, and chronic kidney disease, presented to our hospital for a follow-up coronary angiography (CAG) 6 months after PCI. He had undergone CAG and PCI several times as described below.In 2003, an electrocardiogram showed ST segment depression, and a cardiac exercise stress test and radioisotope revealed ischemic changes in the anterior and inferior segments of the left ventricle; therefore, CAG was performed for the first time. CAG demonstrated 90% stenosis in the proximal right coronary artery (RCA) and 75% stenosis in the proximal left anterior descending artery (LAD) with mild stenosis in the left circumflex artery (LCX). PCI was successfully performed, and bare-metal stents (BMSs; 4.0 × 13 mm and 3.5 × 20 mm) were implanted in the ostium of the RCA and proximal LAD, respectively. Six months later, in 2004, a follow-up CAG revealed no in-stent restenosis (ISR), and dual antiplatelet therapy (DAPT) was changed to single antiplatelet therapy (SAPT). In 2014, the patient was diagnosed with earlystage gastric cancer, and CAG was performed before the gastric cancer surgery. CAG revealed ISR in the RCA and progression of the stenosis in the LCX. A week before the surgery, SAPT was changed to heparin, and DAPT was started after it. Following the surgery, PCI was performed and a zotarolimus-eluting stent (Resolute Integlity 2.5 × 22 mm) was implanted in the LCX,...

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“…9) Although it is not fully understood why SF causes adverse coronary events, the mechanisms are probably related to lower drug delivery at the fracture site and higher mechanical irritation by the fractured struts, causing smooth muscle cell proliferation, and impaired reendothelialization. In addition to these factors, in-stent neoatherosclerotic development might be a mechanism of Uchida, ET AL late coronary events including stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, stent fracture (SF) after DES implantation has recently become an important problem because of its potential association with ISR, target lesion revascularization, and stent thrombosis. [9][10][11] However, the influence of SF on restenotic neointimal tissue characterization after DES implantation has not been fully evaluated.…”

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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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Clinical outcomes and optimal treatment for stent fracture after drug-eluting stent implantation

Abstract: If patients with SF were continued on combination antiplatelet therapy irrespective of ischemic symptoms, there would occur a low rate of major adverse cardiac events, especially cardiac death associated with SF.

Cited by 43 publications

References 10 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

Coronary Artery Aneurysm Caused by a Stent Fracture

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

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