title: Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique. Report of two cases.
abstract: The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.
authors.affiliation: Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Bucheon, Kyeonggi-do, Republic of Korea. twinpapa@catholic.ac.kr
authors.forename: Seong-Rim
authors.initials: SR
authors.lastname: Kim
authors.forename: Min-Woo
authors.initials: MW
authors.lastname: Baik
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Yoo
authors.forename: Ik-Seong
authors.initials: IS
authors.lastname: Park
authors.forename: Sang-Don
authors.initials: SD
authors.lastname: Kim
authors.forename: Moon-Chan
authors.initials: MC
authors.lastname: Kim
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D002533:Cerebral Angiography; D020099:Coated Materials, Biocompatible; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D019233:Retreatment; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000628:therapy*
chemical_list: D020099:Coated Materials, Biocompatible; D020123:Sirolimus