Flat panel digital detector cinefluoroscopy late following SES or BMS implantation for detection of coronary stent fracture in asymptomatic patients.
BACKGROUND
Coronary stent fracture (SF), is rare and confined mainly in patients treated with sirolimus eluting stents (SES). The role of flat panel digital detector (FPDD) fluoroscopy in detecting SF has not been investigated.


METHODS
Assessment with FPDD fluoroscopy of asymptomatic patients, with 200 SES (Cypher, Cordis, J&J, Miami, Florida, US), and 200 bare metal stents (BMS), at 45.5 ± 15.7 and 38.4 ± 3.9 months post-stenting respectively. SF was defined as discontinuity of stent struts on fluoroscopy. Coronary angiography was reserved for patients with documented SF.


RESULTS
Effective radiation dose was 0.26 ± 0.14 mSv. SF was depicted in 6 (3%) SES, and 1 BMS (0.5%). Stent length was an independent predictor of SF (OR 1.19, 95% CI 1.03-1.4, p=0.024). RCA location and vessel angulation were marginally significant (OR 7.7, 95% CI 0.8-74.2, p=0.077 and OR 5.1, 95% CI 0.8-34, p=0.089). Significant angiographic restenosis was detected in 4 SES (66.6%), and 1 BMS (0.5%). Re-intervention was needed in 3 (42.8%) cases, (2 SES and 1 BMS).


CONCLUSIONS
Detection of SF with FPDD cinefluoroscopy late following coronary stenting is feasible, involves low radiation and is confined mainly to SES compared to BMS. Application of cinefluoroscopy as part of a routine stent surveillance programme in asymptomatic patients may be more appropriate in "high risk" settings (SES, long stents and adverse angiographic characteristics). The role of invasive imaging and subsequent management of such patients need further studying.
Cardiology Department, Patras University Hospital, Patras, Greece. pdav@otenet.gr
Periklis A
PA
Davlouros
Corina
C
Chefneux
Ioanna
I
Xanthopoulou
Maria
M
Papathanasiou
Evaggelia
E
Zaharioglou
Grigorios
G
Tsigkas
Dimitrios
D
Alexopoulos
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D002932:Cineangiography / Q000295:instrumentation / Q000379:methods*; D002933:Cineradiography; D017023:Coronary Angiography / Q000379:methods*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D013997:Time Factors
D008670:Metals; D020123:Sirolimus