Coronary Stent Fracture Research Articles

Coronary stent fracture and application of interactive design: a narrative review

Coronary stent fracture and application of interactive design: a narrative review

Coronary Stent Fracture Causing Myocardial Infarction: Case Report and Review of Literature.

Coronary stent fracture (SF) is a potential cause of stent failure increasing the risk for in-stent restenosis, stent thrombosis, target lesion revascularization and major adverse cardiac events. Overall incidence of SF ranges from 1.0% up to 18.6% and SF can be found in up to 60% of failed devices. Advanced imaging techniques have improved the detection of SF. However, defining the optimal therapeutic approach towards these complex lesions is challenging. This review summarizes the most important publications on the topic of SF and discusses current insights into pathophysiology, diagnostic tools, classification and therapeutic management. Furthermore, two illustrative cases of SF leading to myocardial infarction are presented, which demonstrate typical SF risk factors such as vessel angulation and hinge motion, stenting in the right coronary artery, use of long stents and multiple stent layers.

Surgical treatment of a giant right coronary aneurysm following coronary stent fracture

Coronary artery aneurysm represents a challenging and potentially fatal disease. We present the case of a giant right coronary artery aneurysm treated surgically after percutaneous intervention and fracture of the stent. The aneurism was opened and the coronary ligated proximally and distally. It was not possible to re-established continuity of the coronary artery or perform a bypass graft. An early surgical strategy would have re-established blood flow in the involved coronary artery and avoided chronic ischemia of the supplied myocardial territory.

Coronary stent fracture in an octogenarian patient: from bad to worse.

Coronary stent fracture in an octogenarian patient: from bad to worse.

Coronary Stent Fracture in a Patient with an Atrial Septal Defect and Severe Pulmonary Hypertension

Coronary Stent Fracture in a Patient with an Atrial Septal Defect and Severe Pulmonary Hypertension

Prediction of stenting related adverse events through patient-specific finite element modelling

Right ventricular outflow tract (RVOT) calcific obstruction is frequent after homograft conduit implantation to treat congenital heart disease. Stenting and percutaneous pulmonary valve implantation (PPVI) can relieve the obstruction and prolong the conduit lifespan, but require accurate pre-procedural evaluation to minimize the risk of coronary artery (CA) compression, stent fracture, conduit injury or arterial distortion.Herein, we test patient-specific finite element (FE) modeling as a tool to assess stenting feasibility and investigate clinically relevant risks associated to the percutaneous intervention.Three patients undergoing attempted PPVI due to calcific RVOT conduit failure were enrolled; the calcific RVOT, the aortic root and the proximal CA were segmented on CT scans for each patient. We numerically reproduced RVOT balloon angioplasty to test procedure feasibility and the subsequent RVOT pre-stenting expanding the stent through a balloon-in-balloon delivery system.Our FE framework predicted the occurrence of CA compression in the patient excluded from the real procedure. In the two patients undergoing RVOT stenting, numerical results were consistent with intraprocedural in-vivo fluoroscopic evidences. Furthermore, it quantified the stresses on the stent and on the relevant native structures, highlighting their marked dependence on the extent, shape and location of the calcific deposits. Stent deployment induced displacement and mechanical loading of the calcific deposits, also impacting on the adjacent anatomical structures.This novel workflow has the potential to tackle the analysis of complex RVOT clinical scenarios, pinpointing the procedure impact on the dysfunctional anatomy and elucidating potential periprocedural complications.

Very delayed coronary stent fracture presenting as unstable angina: A case report

Very delayed coronary stent fracture presenting as unstable angina: A case report

Impact of Coronary Stent Fracture on Restenotic Neointimal Tissue Characterization After Drug-Eluting Stent Implantation.

Although drug-eluting stents (DESs) reduce the rates of in-stent restenosis (ISR) and subsequent target lesion revascularization, stent fracture (SF) after DES implantation has become an important concern because of its potential association with restenosis and stent thrombosis. We aimed to assess the pathogenic impact of SF on in-stent restenotic neointimal tissue components after DES implantation. We analyzed 43 consecutive patients (14 with SF and 29 without SF) with ISR requiring revascularization after DES implantation between January 2008 and March 2014. For evaluation of in-stent tissue components, integrated backscatter intravascular ultrasound (IB-IVUS) was performed. SF was defined as complete or partial separation of stent segments observed using plain fluoroscopy or intravascular ultrasound. On volumetric IB-IVUS analyses, patients with SF had a significantly higher percentage of lipid tissue volume within the neointima and a significantly lower percentage of fibrous tissue volume than those without (37.3 ± 18.9% versus 24.9 ± 12.4%, P = 0.02, and 61.2 ± 18.3 versus 72.6 ± 12.1%, P = 0.04, respectively). Moreover, SF was positively correlated with the percentage of lipid volume on multiple linear regression analysis after adjustment for confounding factors (β = 0.36, P = 0.03). The interval from stent implantation was similar in both groups (47.0 ± 28.7 versus 37.7 ± 33.3 months; P = 0.39). In conclusion, SF is associated with larger lipid tissue volume within the neointima after DES placement, suggesting a contribution to the development of neoatherosclerosis and vulnerable neointima. Thus SF might lead to future adverse coronary events.

Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes

BackgroundAdverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established.ObjectivesTo describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes.MethodsAll patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed.Results31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis).ConclusionAs a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.

Systematic Analysis of the Incidence of Coronary Stent Fracture and Adverse Events in Japan

Systematic Analysis of the Incidence of Coronary Stent Fracture and Adverse Events in Japan

TCTAP C-154 Coronary Aneurysm and Stent Fracture Following Stenting of a Myocardial Bridge

TCTAP C-154 Coronary Aneurysm and Stent Fracture Following Stenting of a Myocardial Bridge

Coronary stent durability and fracture: an independent bench comparison of six contemporary designs using a repetitive bend test.

Stent fracture is important because it may cause adverse events. The interventional cardiologist needs independent data to aid stent selection. Stent designers need data to improve stent design. We used a repetitive bend test to compare durability and fracture for different stent designs. Tested were 15 examples of six designs (BioMatrix Flex, Vision, MULTI-LINK 8, Element, Promus PREMIER and Integrity). One end of a nominally deployed stent was mounted on a fixed mandrel. The other end was translated a distance of ±3.5 mm at a rate of 6 Hz until fracture or 10 million cycles completed. The numbers of cycles to fracture for the Vision design (288,411±193,391) and the MULTI-LINK 8 (314,475±239,869) were significantly greater than for the BioMatrix Flex design (38,904±13,160), p<0.001. The difference between Vision and MULTI-LINK 8 was not significant (p=0.79). The Element, PREMIER, and Integrity designs did not fracture. Most fractures were in the curved portions of connectors between hoops. The stent design which fractured most readily was the BioMatrix Flex. The most flexible designs did not fracture and, in general, stents with three connectors were more likely to fracture than those with two connectors between loops.

STENT FRACTURE DETECTION USING INTRACORONARY OPTICAL COHERENCE TOMOGRAPHY: A PROOF OF CONCEPT AND COMPARISON OF THREE DIMENSIONAL IMAGING MODALITIES

Coronary stent fracture (SF) has been associated with late stent complications including restenosis and thrombosis. Detection of in-vivo SF may help with understanding the natural history of stent pathology. Two-dimensional intracoronary imaging has been reported as a tool to improve the accuracy of

Fracture of coronary artery sirolimus eluting stent with formation of four aneurysms

Coronary stent fracture is a relatively rare but potentially serious complication of coronary artery stenting, in particular with sirolimus-eluting stents. It has been recognized as one possible cause of in-stent restenosis as well as acute stent thrombosis. The formation of coronary artery aneurysm is one of the critical complications after percutaneous coronary intervention and it has been described after a stent fracture too. We report here a case of formation of four coronary artery aneurysms associated with the fracture of a sirolimus-eluting stent.

Recurrent and Multiple-site Stent Fractures in the Left Anterior Descending Artery: A Case Report and Literature Review

Coronary artery stent fracture (SF) occurs in drug-eluting stent (DES) era but recurrent and multiple DES fracture was rare. We report a case of recurrent and multiple-site SF and review the literature regarding the prevalence, possible mechanism, and management of recurrent SF. If recurrent SF occurs, the deployment of an alternative DES, except sirolimus-eluting stent, is the option of successful management.

Coronary stent fracture mechanisms and clinical implications assessed by multimodality imaging

Coronary stent fracture mechanisms and clinical implications assessed by multimodality imaging

Coronary stent fracture: a recently appreciated phenomenon with clinical relevance.

In the stent era, in addition to restenosis, there are many important consequences deserving more attention. Firstly described in peripheral vascular interventions, it took several years for stent fracture to be known as an appreciable complication of coronary intervention. Especially with the introduction of drug eluting stents and the use of coronary stents in more complex cases, its prevalence has raised and new data have been published concerning its mechanism, predictors, diagnosis, clinical course and treatments. This review will discuss the available literature about stent fracture.

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

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 …

Influence of plaque calcifications on coronary stent fracture: A numerical fatigue life analysis including cardiac wall movement

Coronary stent fracture is still an unresolved issue in the field of minimally invasive cardiovascular interventions due to its high rate of incidence and uncertain clinical consequences. Recent studies, based on clinical data, proved that there are several factors which can be identified as independently responsible of coronary stent fracture. Among these, calcifications, which increase the local stiffness and heterogeneity of atherosclerotic plaques, seem to play a major role. From a mechanical point of view, stent fracture in coronary arteries is triggered by the cyclic loading of pulsatile blood pressure combined with the movement of cardiac wall.In this context, this study aims at simulating the stent expansion in a model of epicardial atherosclerotic coronary artery and correlating the effects of cyclic blood pressure and cardiac wall movement on the stent fatigue resistance. Two ideal cases of atherosclerotic plaques were modelled: the first one included a localised plaque calcification; the latter one did not include such calcification.Results of stress/strain and fatigue analyses confirmed the influence of the plaque calcification on potential fracture of the devices. In addition, the effects of cardiac wall movement were quantified as more dangerous causes of the stent fatigue fracture with respect to the internal blood pressure oscillations.In conclusion, this study demonstrates the increased risk of coronary stent fracture associated to the presence of localised plaque calcifications. This work also suggests the necessity of more realistic biomechanical models which takes into account the heterogeneity of atherosclerotic plaques in order to assess the mechanical performances of coronary stents.

Intra-Aortic Coronary Stent Fracture Revealed by Stent Boost Imaging and Confirmed by Multislice Computed Tomography

A 77-year-old man was admitted with unstable angina. He had a history of 2-vessel coronary artery bypass grafting and percutaneous coronary intervention of each anastomosis. The proximal anastomosis of the marginal branch (circumflex) bypass grafting was directly stented with a TITAN-2 3.5 × 19-mm