Abstract
IntroductionA bare-metal stent fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome is a rare clinical event that, to the best of our knowledge, has previously not been reported. A stent fracture is a rare complication arising from percutaneous coronary intervention.Case presentationWe present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation.ConclusionA coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction) in a native coronary artery. It was diagnosed angiographically and treated early and effectively.
Highlights
A bare-metal stent fracture as a cause of acute coronary thrombosis and of acute coronary syndrome is a rare clinical event that, to the best of our knowledge, has previously not been reported
A stent fracture is a rare complication of percutaneous coronary intervention (PCI)
Aggressive postdilation of a deployed stent may lead to stent fracture
Summary
Stent fractures have been reported in vascular settings such as in the iliac artery [4] and the subclavian artery [5]. Coronary stent fracture is a rare complication and has been described in venous bypass grafts, deploying either DES or BMS [2]. It is worth noting that the patient had no significant stent fracture predictors such as stent length (it was a relatively short stent), aggressive expansion and location (saphenous vein graft or right coronary artery). This case describes one type of presentation of a stent fracture and how important it is to recognize a stent fracture, even if it is a rare occurrence. ACS: acute coronary syndrome; BMS: bare-metal stent; DES: drug-eluting stent; LAD: left anterior descending artery; MB: muscle brain; MDCT: multidetector computed tomography; PCI: percutaneous coronary intervention
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