Sirolimus-eluting stent fracture with thrombus, visualization by optical coherence tomography

A 72-year-old man, with a history of old myocardial infarction, was admitted for angiography. The angiogram showed a 99% angulated stenosis in the right coronary artery (Panel A). Following implantation of two sirolimus-eluting stents (SES) (CypherTM 3.5×23 mm, 3.5×18 mm) at the culprit lesion and dilatation with a 4 mm balloon at 20 atm, the angulated segment of the artery straightened (Panel B). Intravascular ultrasound demonstrated the well-apposed SES with no stent fracture or plaque protrusion at the angulated site. Three months after cessation of ticlopidine with continued use of aspirin, an angiogram at 6-month follow-up showed a re-angulated coronary artery with contrast filling defect (Panel C). At this site, optical coherence tomography (LightLabTM) revealed the fractured stent at six o'clock with thrombus adhesion (Panel D). Coronary angiographies before (Panel A) and after (Panel B) SES implantation. A well-dilated and straightened coronary was achieved by stenting. Six-month follow-up angiogram (Panel C) showed a re-angulated coronary with contrast filling defect (arrow). Optical coherence tomography images at angulated coronary site show a fractured stent with attached thrombus (Panel D).