title: Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation.
abstract: BACKGROUND
  Stent fracture is one of the possible causes of restenosis after sirolimus-eluting stents (SES) implantation. The aim of our study was to evaluate the prevalence and clinical impact of coronary stent fracture after SES implantation.
  
  
  METHODS
  From our prospective institutional database, 280 patients were treated solely with SES from August 2004 to June 2005. Among the 280 patients, 256 patients with a total of 307 lesions underwent follow-up angiography on an average of 240 days after the procedure.
  
  
  RESULTS
  Stent fractures were observed in eight (2.6%) lesions. Of the eight lesions with stent fracture, five were located in the right coronary artery (RCA), two in the saphenous vein (SV) graft, and one in the left anterior descending coronary artery. The stent fractures were all in the locations that served as hinges during vessel movement in the cardiac contraction cycle. Seven of the eight stent fractures were adjacent to the edge of previously implanted or overlapped stent. Significant multivariate predictors of stent fracture were SV graft location (Odds ratio 35.88; 95% confidence interval 2.73-471.6, P = 0.006), implanted stent length (Odds ratio 1.04; 95% confidence interval 1.01-1.07, P = 0.02), and RCA location (Odds ratio 10.00; 95% confidence interval 1.11-89.67, P = 0.04). In-stent binary restenosis rate was 37.5% and target lesion repeat revascularization rate was 50.0% in patients with stent fracture.
  
  
  CONCLUSIONS
  Stent fracture was likely to be affected by mechanical stress provoked by rigid structures and hinge points. Stent fracture might be associated with the high incidence of target lesion revascularization.
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Gaku
authors.initials: G
authors.lastname: Nakazawa
authors.forename: Kengo
authors.initials: K
authors.lastname: Tanabe
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Hirosada
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakayama
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Yasutomi
authors.initials: Y
authors.lastname: Higashikuni
authors.forename: Syuji
authors.initials: S
authors.lastname: Otsuki
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Yagishita
authors.forename: Sen
authors.initials: S
authors.lastname: Yachi
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hara
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011475:Prosthesis Failure; D012501:Saphenous Vein / Q000000981:diagnostic imaging; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus