Complete Fracture of Sirolimus-Eluting Stent in a Saphenous Vein Graft to Left Anterior Descending Artery

Abstract

Coronary stent fractures have been suggested as a potential new mechanism of restenosis. The mechanical properties of stents were designed not only to prevent vessel recoil, but also to resist the mechanical stress of vessel movement over millions of cardiac cycles. We present a case in which mechanical stress may have contributed to the fracture of a stent implanted in a saphenous vein graft (SVG) to the left coronary artery. The patient was admitted due to chest pain 2 years after receiving a coronary artery bypass graft. A coronary angiography revealed the culprit vessel to be the SVG to the left coronary artery. The graft was stenosed and was stented with a sirolimus-eluting stent. A 6-month follow-up coronary angiography revealed 80% in-stent restenosis with stent fracture. We re-intervened by balloon angioplasty. This is the first report of sirolimus-eluting stent fracture combined with restenosis of SVG in Korea.

Two Cases of Percutaneous Intervention for Coronary Artery Bypass Graft Anastomoses With Paclitaxel-Eluting Balloon Catheters

“…However, SVG intervention is challenging because of the high rate of periprocedural myocardial infarction and restenosis 9). In addition, a stent in the SVG can fracture due to movement of the SVG 10). Recent reports have demonstrated that drug-eluting stents and embolic protection devices lead to good results in the management of SVG disease 11)12).…”

“… 9) In addition, a stent in the SVG can fracture due to movement of the SVG. 10) Recent reports have demonstrated that drug-eluting stents and embolic protection devices lead to good results in the management of SVG disease. 11) 12) Because a LIMA graft has high patency rate, LIMA intervention is not performed frequently.…”