Stent Fracture after Everolimus-Eluting Stent Implantation

Abstract

Compared with bare-metal stents, drug-eluting stents (DES) have greatly reduced the risk of in-stent restenosis (ISR) by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF) has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES) may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs) represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR.

A case of repeated stent fracture

“…The incidence of stent fracture in clinical practice has increased significantly in recent years due to the development of stents with thinner steels and the widespread use of intraluminal imaging technology [ 5 ]. Risk factors for stent fracture include longer stent length, overlapping stent edges, angulated and calcified lesions, sirolimus-eluting stents, right coronary artery lesions, saphenous vein lesions and aggressive dilatation [ 1 , 3 , 6 ]. There is no standardized treatment, and PCI is effective for symptomatic and ischemic lesions, and the use of DES is considered the most reasonable [ 7 , 8 ].…”

“…The use of drug-eluting stent (DES) is common in percutaneous coronary intervention (PCI) for coronary artery disease. Although DES reduced in-stent restenosis by inhibiting neointimal tissue proliferation, stent fracture, in which the stent tears, has been reported as one of the complications of DES implantation [ 1 ]. Stent fracture has become a major concern after DES implantation due to its potential association with in-stent restenosis and stent thrombosis [ 2 ].…”

Stent fracture: Broken stents—Broken hearts

“…Wiring through the fractured segment may not be possible, especially in cases of wide stent fragment separation or in cases of aneurysm formation, necessitating cardiac surgery. As seen in the present case, implantation of another stent may be required to restore optimal antegrade flow, yet this may also carry the risk for recurrent stent fracture [9]. Use of an endothelial progenitor cell capturing stent may improve endothelialization, but is also subject to the same risk for recurrent metal fracture.…”

“…Most stent fracture cases have been reported in patients receiving a Cypher stent, likely due to its closed cell, thick‐strut design, and its high radiopacity that facilitates visualization of the fracture. However, stent fractures have been observed with all stents including second generation drug‐eluting stents [9, 10]. As interventionalists, we have no control on the angiographic characteristics of the target lesion, but we can customize the stent choice and deployment strategy.…”

“…Overexpansion of the stents should be avoided as it could weaken the struts and predispose to fracture. Since the Cypher stent is no longer available for clinical use, we are likely to encounter stent fractures less frequently, although stent fractures will likely continue to be seen [9, 10].…”