Predictors and Prognosis of Stent Fracture After Sirolimus-Eluting Stent Implantation

Ino, Yasushi; Toyoda, Yasuaki; Tanaka, Atsushi; Ishii, Shuuta; Kusuyama, Yoshio; Kubo, Takashi; Takarada, Shigeho; Kitabata, Hironori; Tanimoto, Takashi; Mizukoshi, Masato; Imanishi, Toshio; Akasaka, Takashi

doi:10.1253/circj.cj-09-0343

Cited by 51 publications

(76 citation statements)

References 27 publications

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“…26, 27 The subject group, however, may have been too small to show the effects of stent fracture on VLST. Although stent fracture was often seen within 1 year after DES implantation, the present study showed that VLST with stent fracture occurred at various times even after 1 year after DES implantation.…”

Section: Discussionmentioning

confidence: 99%

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Kubo

Kadota

Ozaki

et al. 2013

Circ J

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Background: Limited data are available with which to compare the clinical characteristics of patients with very late stent thrombosis (VLST) after drug-eluting stent (DES) or bare-metal stent (BMS) implantation. The purpose of this study was to investigate the differences in the characteristics of VLST after DES and BMS implantation by reviewing the clinical and angiographic data. Methods and Results:A total of 28 patients (30 lesions) with VLST after DES implantation and 33 patients (33 lesions) with VLST after BMS implantation were identified. The occurrence of VLST after BMS implantation (2,647±996 days) was much later than that after DES implantation (1,194±558 days, P<0.001). The number of VLST after DES implantation increased gradually each year; however VLST after BMS implantation started to occur >50 months later, and its number increased subsequently. The prevalence of VLST related to surgical procedures involving discontinuation of antiplatelet therapy in VLST patients was higher after DES implantation (14.3%) than after BMS implantation (0%, P=0.039). Angiographic stent fracture was seen in 36.7% of VLST lesions after DES implantation at different times (464-2,102 days after procedure), while none was seen in VLST lesions after BMS implantation (P<0.001). Conclusions:The timing of VLST was different after DES and BMS implantation. Stent fracture was a specific finding of VLST after DES implantation. (Circ J 2013; 77: 1453 -1460

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Section: Discussionmentioning

confidence: 99%

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Kubo

Kadota

Ozaki

et al. 2013

Circ J

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“…However, not only did angulation of the coronary artery change after stenting, 6) but also shear stress potency near the proximal portion of the coronary arteries (ie, LCA and RCA), including the aortic ostium. These occurrences were major factors in causing fractures.…”

Section: Discussionmentioning

confidence: 99%

“…4) Additionally, a lack of neointimal growth inside the SES is also attributable to the SF and migration into the aorta. 6) Based on these factors, complex SF was established after T-stenting at the LMCA distal bifurcation. The present case report provides the first direct evidence of striations in a fractured segment of the SES observed using electron microscopy images.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, patients implanted with SES should be carefully observed, particularly those with a high likelihood of having fracture in the SES. [1][2][3][4][5][6][7] Furthermore, since the structure of the Cypher Select+ ® (approved in February 2010 in Japan) was modified to withstand shear stress through extension of the flex segment with an oblique angle, the incidence of SF and the long-term clinical and angiographic outcomes as well as outcomes of MSCT after implantation with Cypher Select+ ® should be estimated. All 7 flex segments linking the cells (radial-strength segments) were found to be fractured ( Figure 3A).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, previous reports suggest that shear stress induced by coronary movement and hinge motion, SES length and overlap, tortuosity of the right coronary artery (RCA), interval after stent placement, small stent diameter, lack of stent protection by the neointima, and changes in angulation after SES placement are factors related to SF. [1][2][3][4][5][6][7] However, the direct outcome of continuous shear stress, which causes fracture of the stainless steel-based platform of the SES after placement in native coronary arteries, is not fully understood.…”

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confidence: 99%

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Direct Microscopic Observation of Striations in a Fractured Section of a Sirolimus-Eluting Stent (Cypher Bx Velocity) Indicates Induction of Stent Fracture by Continuous Shear Stress

et al. 2011

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SummaryA 73-year-old woman with severe congestive heart failure was treated by implantation with a sirolimus-eluting stent (SES; Cypher Bx Velocity ® ) in the left main coronary artery (LMCA) using the staged T-stent, kissing balloon, and hugging balloon techniques. Follow-up coronary multislice computed tomography after 10 months revealed that SES was completely fractured in 2 directions; the fractured stent appeared in the shape of the letter "L" and had migrated into the aorta. An SES fragment was surgically removed and subsequent electron microscopy revealed striations (striped patterns in fractured sections) on the fracture plane, indicating continuous shear stress after SES implantation in the LMCA. This case provides direct evidence of continuous shear stress on the SES and indicates the necessity of improving the structure of the stent such that it can withstand shear stress. ( , and this fracture leads to adverse clinical outcomes, including stent thrombosis and angiographic in-stent restenosis (ISR).1-3) The mechanism of fracture of the SES is still under investigation, and several factors related to SF have been reported. First, oversized ballooning and high pressure ballooning during the procedure are a major factor related to immediate and mechanical SF. Additionally, previous reports suggest that shear stress induced by coronary movement and hinge motion, SES length and overlap, tortuosity of the right coronary artery (RCA), interval after stent placement, small stent diameter, lack of stent protection by the neointima, and changes in angulation after SES placement are factors related to SF.1-7) However, the direct outcome of continuous shear stress, which causes fracture of the stainless steel-based platform of the SES after placement in native coronary arteries, is not fully understood.In this case report, we present electron microscope images of the fractured SES plane obtained from a surgically removed fragment after its asymptomatic migration into the aorta; the migration occurred because of complete SF after revascularization of the left main coronary artery (LMCA) using the conventional T-stent technique. Case ReportA 73-year-old woman was diagnosed with acute inferior The kissing balloon technique (KBT) and hugging balloon technique (HBT) were performed during the T-stent procedure using 2.5-and 3.0-mm compliant balloons (D) and 3.0-and 3.5-mm noncompliant balloons E and F. An SES split, as seen in the final angiogram (indicated by the black arrow in G).

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Decreased risk of stent fracture‐related restenosis between paclitaxel‐eluting stents and sirolimus eluting stents: Results of long‐term follow‐up

Freixa

Almasood

Khan

et al. 2011

Cathet Cardio Intervent

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Predictors and Prognosis of Stent Fracture After Sirolimus-Eluting Stent Implantation

Cited by 51 publications

References 27 publications

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Difference in Clinical and Angiographic Characteristics of Very Late Stent Thrombosis Between Drug-Eluting and Bare-Metal Stent Implantations

Direct Microscopic Observation of Striations in a Fractured Section of a Sirolimus-Eluting Stent (Cypher Bx Velocity) Indicates Induction of Stent Fracture by Continuous Shear Stress

Decreased risk of stent fracture‐related restenosis between paclitaxel‐eluting stents and sirolimus eluting stents: Results of long‐term follow‐up

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