Korean Circ J.  2008 Jan;38(1):69-71. 10.4070/kcj.2008.38.1.69.

A Sirolimus: Eluting Stent Fracture Combined with a Coronary Artery Aneurysm

• Lee SY
• Im E
• Yang WI
• Kim JS
• Cho YH
• Shim WH

• KMID: 2225877
• DOI: http://doi.org/10.4070/kcj.2008.38.1.69

Abstract

A stent fracture combined with a coronary artery aneurysm is a rare event. As these events can lead to a harmful outcome, such as the development of myocardial ischemia by in-stent restenosis or thrombosis, repeated coronary intervention may be required. We report a case of a stent fracture combined with a coronary artery aneurysm. The fracture was thought to have developed by mechanical stress produced from a change of regional wall motion after an anteroseptal myocardial infarction. As detected by the use of intravascular ultrasound, neither in-stent restenosis nor a thrombus in the fractured stent was present. A cardiac magnetic resonance image showed that no viable myocardium in the anteroseptal wall was present. Therefore, the patient underwent medical treatment without intervention of the fractured stent.

Keyword

Stents; Complications; Fracture; Aneurysm

MeSH Terms

Aneurysm
Anterior Wall Myocardial Infarction
Coronary Vessels
Humans
Magnetic Resonance Spectroscopy
Myocardial Ischemia
Myocardium
Stents
Stress, Mechanical
Thrombosis

Figure

• 

  Fig. 1 Serial findings of coronary angiogram. A: initial coronary angiography showed diffuse stenosis in the proximal and mid portions of the LAD. B: post PCI angiography revealed well-deployed overlapping SESs, but the big septal artery (arrow) was totally occluded. C: fluoroscopy at follow-up showed a complete SES fracture. D: coronary angiography showed coronary artery aneurysm (arrowhead) at the fractured site. LAD: left anterior descending artery, PCI: percutaneous coronary intervention, SES: sirolimus-eluting stent.

• 

  Fig. 2 IVUS at follow-up angiography confirmed a complete stent fracture with coronary artery aneurysm (arrow heads). IVUS: intravascular ultrasound.

• 

  Fig. 3 Cardiac MRI revealed myocardial thinning with transmural delayed hyperenhancement (arrow) on the anteroseptal area.

Reference

1. Brilakis ES, Maniu C, Wahl M, Barsness G. Unstable angina due to stent fracture. J Invasive Cardiol. 2004. 16:545.

2. Sianos G, Hofma S, Ligthart JM, et al. Stent fracture and resenosis in the drug-eluting stent era. Catheter Cardiovasc Interv. 2004. 61:111–116.

3. Min PK, Yoon YW, Kwon HM. Delayed strut fracture of sirolimus-eluting stent: a significant problem or an occasional observation? Int J Cardiol. 2006. 106:404–406.

4. Surmely JF, Kinoshita Y, Dash D, et al. Stent strut fracture-induced restenosis in a bifurcation lesion treated with the crush stenting technique. Circ J. 2006. 70:936–938.

5. Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation. 2003. 108:1701–1706.

6. Bae JH, Hyun DW, Kim KY, Yoon Hj, Nakamura S. Drug-eluting stent strut fracture as a cause of restenosis. Korean Circ J. 2005. 35:787–789.

7. Kim JS, Yoon YW, Hong BK, et al. Delayed stent fracture after successful sirolimus-eluting stent (Cypher®) implantation. Korean Circ J. 2006. 36:443–449.

8. Kim EJ, Rha SW, Wani SP, et al. Coronary stent fracture and restenosis in the drug-eluting stent era: do we have clues of management? Int J Cardiol. 2007. 120:417–419.

9. Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006. 48:193–202.