Clinical characteristics of stent fracture after sirolimus-eluting stent implantation☆

Abstract 

Background

Despite several case reports of sirolimus-eluting stent (SES) fracture and concern regarding restenosis after successful SES implantation, the clinical characteristics of this problem are not well known.

Methods

Clinical records and angiographic films of patients who received follow-up coronary angiography between February 2005 and October 2006 were retrospectively analyzed.

Results

Among the 686 SES implanted in 479 patients, 27 fractures were found in 22 (3.2%) stents in 18 patients. All stent fractures occurred in long stented segments, i.e. ≥28 mm (range, 28 mm to 83 mm). Of the 22 fractured stents, sixteen (72.7%) were identified in the right coronary artery (RCA) and fifteen (68.2%) were found to have a fracture site within 10 mm from areas with increased rigidity due to metal overlap. The significant multivariate predictors of stent fracture were the stented length (Odds ratio 1.06; 95% confidence interval 1.04–1.09; p=0.001) and the RCA location (Odds ratio 4.44; 95% confidence interval 1.66–11.86; p=0.003). The binary restenosis rate was 22.7% and target lesion revascularization was performed in two (9.1%) fractured stents.

Conclusions

SES fracture was associated with a long stented segment, RCA location and metal overlap. Stent fracture may be another potential risk factor for restenosis after successful SES implantation.

Keywords: Sirolimus, Stent, Fracture