Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation.
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.
Aoki
Jiro
J
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Nakazawa
Gaku
G
Tanabe
Kengo
K
Hoye
Angela
A
Yamamoto
Hirosada
H
Nakayama
Tomohiro
T
Onuma
Yoshinobu
Y
Higashikuni
Yasutomi
Y
Otsuki
Syuji
S
Yagishita
Atsuhiko
A
Yachi
Sen
S
Nakajima
Hiroyoshi
H
Hara
Kazuhiro
K
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
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus