Clinical outcomes and optimal treatment for stent fracture after drug-eluting stent implantation.
BACKGROUND
Many studies have suggested that in the era of drug-eluting stents (DES) one of the causes of in-stent restenosis is stent fracture (SF). Yet there have been few studies of the major adverse cardiac events and treatment of DES SF.


RESULTS
From September 2003 to May 2008, 3365 patients received successful stent implantation with DES, of whom 1009 patients underwent a follow-up coronary angiography irrespective of symptoms. Seventeen SFs were detected in 15/1009 patients (1.5%). All SF patients were continued on medication with combination antiplatelet therapy, regardless of angina symptoms. If in-stent restenosis at the fractured site was significant, we performed coronary interventions even in patients without ischemic symptoms. Patients were treated with heterogenous DES for restenosis lesions (5/8 patients), and the rest were treated with either homogenous DES (2 patients), or plain old balloon angioplasty (1 patient) or medical treatment (7 patients). None of the SF patients suffered from cardiac death during a follow-up period of 20.4+/-12.3 months.


CONCLUSIONS
If patients with SF were continued on combination antiplatelet therapy irrespective of ischemic symptoms, there would occur a low rate of major adverse cardiac events, especially cardiac death associated with SF.
Lee
Shin Eun
SE
The Heart Center of Chonnam National University Hospital, Dong Ku, Gwangju, South Korea.
Jeong
Myung Ho
MH
Kim
In Soo
IS
Ko
Jum Suk
JS
Lee
Min Goo
MG
Kang
Won Yu
WY
Kim
Soo Hyun
SH
Sim
Doo Sun
DS
Park
Keun Ho
KH
Yoon
Nam Sik
NS
Yoon
Hyun Ju
HJ
Kim
Kye Hun
KH
Hong
Young Joon
YJ
Park
Hyung Wook
HW
Kim
Ju Han
JH
Ahn
Young Keun
YK
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011379:Prognosis; D011475:Prosthesis Failure; D012189:Retrospective Studies
D010975:Platelet Aggregation Inhibitors