Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database

Abstract

SF occurs most commonly in first generation Cypher stents with a similar distribution of cases across different contemporary platforms. Optimal treatment strategy remains unclear with the decision to treat and the modality of treatment utilized depending on the type and severity of SF.

Prospective Identification of Stent Fracture by Enhanced Stent Visualization System During Percutaneous Coronary Intervention

“…5 A recent analysis from the Food and Drug Administration Manufacturer and User Facility Device Experience Database reports that a further stent was implanted in most cases (68% of patients). 5 In our exploratory analysis, 62% of patients with SF III-IV was treated with further stent implantation, and we found significantly less occurrence of DOCE, as compared with those in whom the operator decided not to implant a further stent (9% vs. 79%, P<0.01).…”

“…5 A recent analysis from the Food and Drug Administration Manufacturer and User Facility Device Experience Database reports that a further stent was implanted in most cases (68% of patients). 5 In our exploratory analysis, 62% of patients with SF III-IV was treated with further stent implantation, and we found significantly less occurrence of DOCE, as compared with those in whom the operator decided not to implant a further stent (9% vs. 79%, P<0.01). However, it is noteworthy that when SF is caused by non-modifiable factors such as excessive vessel tortuosity, complex bifurcation stenosis or heavy calcification, it is doubtful whether this strategy should be adopted because all these factors still persist and may even be worsened, because overlapped stents themselves predispose to SF.…”

“…Moreover, the fractured struts may act as additional source of inflammation and hyperplasia because of poor distribution or interruption of drug delivery, leading to neointimal overgrowth as a response to injury and subsequent stenosis. 5 Moreover, changes in local shear stress may cause focal differences in vascular compliance, thus enhancing extracellular matrix deposition. 5 With regard to stent platforms, we found a slightly higher percentage of SF III-IV…”

“…5 Moreover, changes in local shear stress may cause focal differences in vascular compliance, thus enhancing extracellular matrix deposition. 5 With regard to stent platforms, we found a slightly higher percentage of SF III-IV…”

Bioresorbable Vascular Scaffold: A Pioneering Solution for In-Stent Restenosis of stent fracture on right coronary artery

“…1 The main factors involving in stent fracture are: coronary location, tortuosity, calcification, stent design, strut thickness and incomplete stent apposition. 2 Optimal treatment strategy remains unclear with the decision to treat and the modality of treatment utilized depending on the type and severity of SF, the clinical presentation, and the presence of anatomical factors that predict possible recurrence. However, in our case the choice to treat the stent fracture with BVS was forced by need not to implant a very long additional metallic layer.…”