Coronary stent fracture resulting in pseudoaneurysm

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A 72-year-old male with past history of type 2 diabetes mellitus and coronary artery bypass grafting presented with progressive angina 6 months following a percutaneous coronary intervention (PCI) for diffuse in-stent restenosis (ISR) of a drug eluting stent (Taxus Liberte) implanted in tortuous left circumflex artery (LCx). The ISR was treated using a paclitaxel-eluting balloon. The CT angiography revealed a fracture of the stent with complete separation of the 2 segments with malalignment and a gap of 5 mm (Fig. 1, panel A, B arrow head). The proximal segment was communicating with a large pseudoaneurysm (Fig. 1, panel A, B arrow). The LCx was totally occluded distal to the communication. Fig. 1 CT coronary angiography: Complete stent fracture with malalignment of two segments and a gap of 5mm, the proximal segment communicating with a large pseudoaneurysm. Panel A: Axial cut. Panel B: 3D reconstructed image. Fracture of the stent was possibly because of shear force on the curve of the LCx artery resulting from cardiac contractions. The paclitaxel induced inflammatory changes in the vessel wall could have contributed in the weakening of the arterial wall resulting in the pseudoaneurysm. The pseudoaneurysm was successfully closed with 3 stainless steel coils (Cook Inc., Bloomington, IN, USA) (MWCE-18-3-3).