Clinical outcomes and optimal treatment for stent fracture after drug-eluting stent implantation

Abstract

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. 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. 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.