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Stent Fracture with total occlusion after Drug-Eluting Stent Implantation

- Operator : Duk-Woo Park

Stent Fracture with total occlusion after Drug-Eluting Stent Implantation
- Operator: Duk-Woo Park, MD
Clinical Information

-Relevant clinical history and physical exam
A 65 year-old female patient with a risk factor of smoking visited hospital with effort related chest pain for 1 month ago (Oct, 2005). She was diagnosed as unstable angina and received DES implantation. After 2 years (Dec, 2007), she visited hospital with acceleration angina despite of medical therapy.

-Relevant test results prior to catheterization
The ECG did not show any significant ST-segment changes. Echocardiography showed no wall motion abnormality with normal systolic function.

-Relevant catheterization findings
Baseline coronary angiogram showed a diffuse 80% narrowing of distal LCX, subtotal occlusion of mid LAD and diffuse 60% narrowing of RCA (Figure 1, Figure 2, Figure 3).


Interventional Management
- Procedural step:
A 0.014 inch Floppy guide-wire was placed into the LCX. Predilation was performed with a 2.5X20mm Pleon balloon (compliant balloon) at distal LCX (Figure 4, Figure 5). After predilation, Cypher (3.0X33mm) was implanted (Figure 6). LAD was treated with balloon angioplasty. Final angiogram showed well deployed stent without residual stenosis or dissection and the presence of TIMI 3 flow.
After 2 years from stent implantation (Dec, 2007) follow-up coronary angiogram showed stent fracture at mid portion of mid LCX stent with TIMI 0 flow (Figure 7, Figure 8). She underwent CABG (LIMA-LAD, SV-dRCA, SV-OM) (Figure 9, Figure 10)

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