Coronary Stent Fracture Complicated Multiple Aneurysms Confirmed by 3-Dimensional Reconstruction of Intravascular-Optical Coherence Tomography in a Patient Treated With Open-Cell Designed Drug-Eluting Stent

Abstract

A 55-year-old man with a previous history of cerebral infarct and hypertension presented to our cardiovascular center complaining of angina in November 2011. Chronic total occlusion in the proximal left anterior descending artery was identified by coronary angiography (Figure 1A). The patient subsequently underwent percutaneous coronary intervention. Wiring was done successfully with a tapered stiff wire (Conquest Pro 20; ASAHI INTECC). After multiple predilation, a single drug-eluting stent (3.0 × 18 mm) of an open-cell design and bioabsorbable polymer (Nobori; Terumo, Tokyo, Japan) was implanted using a 3.5-mm noncompliant balloon (inflation pressure, 24 atmospheric pressure; Quantum Maverick Balloon; Boston Scientific/Scimed, Maple Grove, MN) for application of final high-pressure postdilation (Figure 1B). The patient has been asymptomatic since percutaneous coronary intervention and on dual antiplatelet therapy. A 6-month scheduled angiographic follow-up demonstrated a structural misalignment at the stent implantation site with a change in focal aneurysm (Figure 1C). Digital subtraction imaging by StentBoost (Subtract; Philips Healthcare, Best, The Netherlands) was done under the suspicion of stent distortion, but the imaging was unclear to clarify the diagnosis (Figure 1D). To determine the precise configuration of the stent, we performed intravascular optical coherence tomography (OCT). Conventional 2-dimensional (2-D) OCT revealed a focal thrombus and 2 additional aneurysms …