The correlation between femoral popliteal artery stent fracture and in-stent restenosis / 介入放射学杂志

Objective To investigate the correlation between femoral popliteal artery stent fracture and in-stent restenosis (ISR) in patients with arteriosclerosis obliterans of superficial femoral artery and proximal popliteal artery after receiving stent implantation.Methods The clinical data of a total of 97 consecutive patients with arteriosclerosis obliterans of superficial femoral artery and proximal popliteal artery (107 diseased limbs in total),who were treated with primary stent implantation during the period from March 2012 to March 2016,were retrospectively analyzed.The imaging materials,including Doppler ultrasonography,plain radiography,contrast-enhanced CT scan,DSA,etc.were collected,and Kaplan-Meier survival analysis and other statistical analysis methods were used to analyze the related data.Results During the follow-up period,71 patients (72 limbs in total) developed ISR and the incidence of ISR was 67.3％ (72/107).The incidences of ISR in the stent-fracture group and non-fracture group were 84.2％ (32/38) and 58.0％ (40/69) respectively,the difference between the two groups was statistically significant (P=0.01).Conclusion After stent implantation of femoral popliteal artery,fracture of stent is one of the important risk factors for the occurrence of ISR.

Stent Fracture at the Proximal Shaft of the Left Main Stem

Stent fracture is likely to be caused due to mechanical stress at the hinge point or kinking movement at the point of aneurysm formation with stent malapposition. To our knowledge, this is the first published report of stent fracture at the proximal shaft of the left main stem in a patient with acute myocardial infarction.

Stent fracture and restenosis after percutaneous transluminal angioplasty and stenting for symptomatic ostial vertebral/subclavian artery stenosis: a report of 3 cases and literature review / 中华神经医学杂志

Objective To discuss mechanism and control measures of stent fracture and restenosis after percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic ostial vertebral/subclavian artery stenosis. Methods A retrospective analysis was performed on 3 patients with stent fracture after receiving PTAS for symptomatic ostial vertebral/subclavian artery stenosis.Simple radiographic, ultrasonographic and clinical follow-up examinations were estimated. Related articles on coronary stent fracture were gone over, consulting in the types, cumulative incidence and occurrence time of adverse events, risk factors and preventive measures. Results Stent fractures of 3 patients with symptomatic ostial vertebral /subclavian artery stenosis were associated with in-stent restenosis and occlusion. Two of the 3 patients treated with the balloon angioplasty and after balloon dilatation, and the patients exhibited relief of symptoms. One patient was only managed for vascular disease risk factors, and no developing recurrent symptoms were noted during the follow-up period.Conclusions Stent fracture might appear in patients performed PTAS for symptomatic ostial vertebral /subclavian artery stenosis, and regular check is needed. Individual treatment was emphasized in case of serious symptoms appeared.

Reestenose tardia associada à fratura de stent Cypher / Late restenosis related to Cypher stent fracture / Reestenosis tardía asociada a fractura de stent Cypher

Os stents farmacológicos representam um importante avanço na terapêutica da doença aterosclerótica coronariana. Recentemente tem sido descrita a fratura de stents farmacológicos, associada à reestenose e trombose. Relataremos aqui um caso de fratura de um stent farmacológico 18 meses após o seu implante, associada com reestenose.

Drug-eluting stents represent a significant evolution in the therapy of coronary artery disease. Recently, restenosis and thrombosis related to drug-eluting stent fractures have been described. This work reports a case of fracture of a drug-eluting stent 18 months after implantation, associated with restenosis.

Los stents farmacológicos representan un importante avance en la terapéutica de la enfermedad aterosclerótica coronaria. Recientemente se ha descrito la fractura de stents farmacológicos, asociada a la reestenosis y trombosis. Relataremos aquí un caso de fractura de un stent farmacológico 18 meses después de su implante, asociada con reestenosis.

Clinical value of intravascular ultrasound in diagnosing stent fracture: report of two cases with literature review / 介入放射学杂志

Stent fracture has been implicated as a cause of drug-eluting stent failure. The authors report here 2 cases with stent fractures which were diagnosed by coronary artery angiography and intravascular ultrasound (IVUS). Both of them received multiple-stent-implantation. Five stent fractures altogether were detected in two patients. All the involved stents were sirolimus-eluting ones. Angiographic study showed that three stent fractures were complete transverse linear fracture with stent displacement. IVUS demonstrated that three stent fractures were complete break and two were partial break. One fracture was located close to the overlapping site of two stents and another fracture was accompanied by the formation of a coronary aneurysm. Angiography and IVUS are helpful to identify stent fracture. In addition, IVUS is more likely to clarify the cause of stent failure as well as the mechanism of stent fracture.

A Case of Stent Strut Fracture of a Paclitaxel-Eluting Stent at the Time of Stent Implantation in a Complex Coronary Lesion

Several cases of stent strut fractures (SSFs) have recently been reported following drug-eluting stent (DES) implantation Although SSF is a rare complication, it has been suggested to be a cause of restenosis. To date, a number of cases of stent fracture have been associated with sirolimus-eluting stents and they occurred from 2 days to about 2 years after the initial procedure. We report here on a case of paclitaxel-eluting stent fracture at the time of stent placement in a calcified coronary lesion.

Delayed Stent Fracture after Successful Sirolimus-Eluting Stent(Cypher(R)) Implantation

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stent (SES) is very effective for preventing in-stent restenosis through the suppression of neointimal proliferation. Treatment failure cases related to stent fracture have recently been reported on, but any studies concerning the pattern or mechanism of SES fracture are very rare. SUBJECTS AND METHODS: Between December 2003 to January 2005, 457 patients underwent follow-up coronary angiography after SES implantation at three referral center. We reviewed the angiographic and procedural data for eleven of theses patients [6 males (55%), mean age: 60 year-old age, range: 43-74 years] who were proven to have experience complete SES fracture. RESULTS: The left anterior descending artery (LAD) and right coronary artery (RCA) stent fracture were 7 cases (63%) and 4 cases (37%), respectively. Myocardial bridge was shown in 6 cases with LAD fracture (86%). Overlapping stent implantation was performed in 5 cases (45%). The mean value of the maximal angulations at the fracture site before intervention was 50 degrees (range; 39-70 degrees) and the mean change between the maximal and minimal angulations was 13.2 degrees (range; 2-28 degrees). The mean stent diameter and length were 3.0 mm (range; 2.75-3.50 mm) and 40 mm (range; 23-52 mm). Stent inflation with high pressure was performed on 6 cases (54%) and it's frequency was higher in the RCA than the LAD (3 cases, 75%, mean inflation pressure: 13.1 mmHg). The mean follow-up duration was 7.2 month and only 2 cases were admitted due to the recurrent chest pain. The binary restenosis rate was 55% (6 cases) and the restenotic lesions were treated by balloon angioplasty in 2 cases and additional stenting was done in 2 cases. CONCLUSION: Our results demonstrated that SES fracture occurred in 7 cases with LAD lesion and in 4 cases with RCA lesion. Long stenting including overlapping implantation and more than 40 degrees angulated long stent implantation may be the factors for SES fracture. Our results also showed high pressure stent inflation was performed more frequently at the RCA lesion, and myocardial bridge and kinking motion was detected more frequently at the LAD lesions.

Drug-Eluting Stent Strut Fracture as a Cause of Restenosis

We report a case of in-stent restenosis due to the fracture of a sirolimus-eluting stent, which was confirmed by intravascular ultrasound. It can be suggested that a stent fracture is an important cause of restenosis in this era of drug-eluting stents.

Imaging identification of stent fracture with drug eluting stent / 中国介入心脏病学杂志

Objective To identify stent fracture by revision of coronary artery angiography and intravascular ultrasound(IVUS) images.Methods Stent fracture has been implicated as a cause of drug-eluting stent failure.IVUS is more likely to identify stent failure(including stent fracture) when compared with angiography.We analysed retrospectively 2 021 cases of angiography and 183 cases of IVUS.Results Six fractures were found in 3 patients by angiography and five of these fractures were confirmed by IVUS in 2 patients.All stent fractures occurred in sirolimus-eluting stents in less than one year after implantation.Angiography analysis showed that 4 stent fractures were complete transverse linear fracture with stent displacement.IVUS analysis showed that 3 stent fractures were complete and 2 were partial fracture.One fracture site was found at the overlapping point of stents and one was found with coronary aneurysm.Conclusion Angiography and IVUS are helpful to identify stent fracture.IVUS can help to understand the possible mechanisms of stent fracture.