J Korean Surg Soc.  2012 Sep;83(3):183-186. 10.4174/jkss.2012.83.3.183.

Stent fractures after superficial femoral artery stenting

• Park JY
• Jeon YS
• Cho SG
• Jin CI
• Kim KR
• Shin WY
• Kim JY
• Hong KC

• KMID: 2212293
• DOI: http://doi.org/10.4174/jkss.2012.83.3.183

Abstract

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.

Keyword

Stents; Vascular patency; Femoral artery; Early intervention

MeSH Terms

Aged
Early Intervention (Education)
Femoral Artery
Humans
Male
Recurrence
Stents
Thrombosis
Vascular Patency

Figure

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  Fig. 1 Follow-up X-ray showed transverse linear fracture and displacement (type IV stent fracture).

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  Fig. 2 The angiography revealed stent occlusion in long segment of stented superficial femoral artery.

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  Fig. 3 The computed tomography angiography showed good patency after bypass surgery with great saphenous vein.

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  Fig. 4 Follow-up X-ray showed multiple fractures of stent struts (type II stent fracture).

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  Fig. 5 The angiography showed instent restenosis of primary stent.

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  Fig. 6 Stenting for stent fracture site after balloon angioplasty (A) with good angiographic results (B).

Reference

1. Adlakha S, Sheikh M, Wu J, Burket MW, Pandya U, Colyer W, et al. Stent fracture in the coronary and peripheral arteries. J Interv Cardiol. 2010. 23:411–419.

2. Schillinger M, Sabeti S, Loewe C, Dick P, Amighi J, Mlekusch W, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006. 354:1879–1888.

3. Iida O, Nanto S, Uematsu M, Morozumi T, Kotani J, Awata M, et al. Effect of exercise on frequency of stent fracture in the superficial femoral artery. Am J Cardiol. 2006. 98:272–274.

4. Scheinert D, Scheinert S, Sax J, Piorkowski C, Braunlich S, Ulrich M, et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005. 45:312–315.

5. Bates MC, Campbell JR, Campbell JE. Late complication of stent fragmentation related to the "lever-arm effect". J Endovasc Ther. 2008. 15:224–230.

6. McKelvey AL, Ritchie RO. Fatigue-crack propagation in Nitinol, a shape-memory and superelastic endovascular stent material. J Biomed Mater Res. 1999. 47:301–308.

7. Duterloo D, Lohle PN, Lampmann LE. Subintimal double-barrel restenting of an occluded primary stented superficial femoral artery. Cardiovasc Intervent Radiol. 2007. 30:474–476.

8. Palena LM, Cester G, Manzi M. Endovascular treatment of in-stent occlusion: new technique for recanalization of long superficial femoral artery occlusion (direct stent puncture technique). Cardiovasc Intervent Radiol. 2012. 35:418–421.

9. Jaff M, Dake M, Pompa J, Ansel G, Yoder T. Standardized evaluation and reporting of stent fractures in clinical trials of noncoronary devices. Catheter Cardiovasc Interv. 2007. 70:460–462.