Clinical Images

Recurrent Stent Fracture: First Reported Image of Everolimus-Eluting Stent Fracture Leading to Recurrent Restenosis in Cardiac Allograft Vasculopathy

Sayed T. Hussain, MD, Imran Arif, MD, Tarek Helmy, MD

Sayed T. Hussain, MD, Imran Arif, MD, Tarek Helmy, MD

We report the follow up of a cardiac transplant patient with allograft vasculopathy previously treated for restenosis related to stent fracture of a sirolimus-eluting stent (3.5 x 23 mm). This is a condition that is commonly underdiagnosed in clinical practice, however, it has been reported in up to 30% of autopsy cases.1 This lesion was treated using an everolimus-eluting stent (3.5 x 28 mm). The patient presented again with “recurrent” stent fracture (fracture of two overlapping layers of stents). This is the first reported image of a “recurrent” fracture of a drug-eluting stent in the treatment of cardiac allograft vasculopathy. It is also the first known case of an everolimus-eluting stent fracture (thin-strut, open-cell design) in any clinical setting. Multiple factors contribute to the mechanism of stent fractures, including the length of stent, stent design and vessel tortuosity. In our case, we believe that it is primarily related to the increased angulation of the stented segment during contraction (hinge point effect). The common approach to stent fracture-related lesions is repeat stenting, but there are no compelling data on the treatment of “recurrent” stent fracture. In our case, the minimal luminal area at the lesion was 5.5 mm2 and an additional stent was not placed.

Reference

1. Nakazawa G, Finn AV, Vorpahl M, et al. Incidence and predictors of drug-eluting stent fracture in human coronary artery: A pathologic analysis. J Am Coll Cardiol 2009;54:1924–1931.
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From the Division of Cardiovascular Diseases, University of Cincinnati, Cincinnati, Ohio. The authors report no conflicts of interest related to the content herein. Manuscript submitted March 5, 2010, provisional acceptance given April 14, 2010, final version accepted April 20, 2010. Address for correspondence: Sayed T. Hussain, MD, Division of Cardiovascular Diseases, University of Cincinnati, 231 Albert Sabin Way, Cincinnati OH 45267. E-mail: sayedthussain@hotmail.com