Key result
A zotarolimus-eluting stent implanted in a tortuous right coronary artery resulted in a very delayed Type V stent fracture four years later, presenting as unstable angina.
Case Report (n=1)
No
This case highlights that despite flexible open-cell designs, long zotarolimus-eluting stents implanted in tortuous vessels can undergo very delayed fracture and present as unstable angina.
Answers are grounded in this paper and cite their sources.
Very late stent fracture may cause late angina after tortuous-vessel stenting; this case leaves open incidence and predictors.
Introduction: Coronary stent fracture represents an under diagnosed clinical event of drug-eluting stents which is often associated with adverse clinical outcomes of in-stent restenosis. Numerous risk factors are associated with stent fracture that include stent overexpansion, creation of hinge points due to stent overlapping, use of longer stents for complex lesions as well as mechanical fatigue causing stent distortion in the right coronary artery and vein grafts. Case Report: A 64-year old male, a cigarette smoker, presented with rest angina. Coronary angiogram showed discrete 99% stenosis in proximal left anterior descending artery and a mid-eccentric 90% lesion in the right coronary artery (RCA). The patient was taken up for angioplasty of both the vessels. A type V fracture was detected after four years of zotarolimus-eluting stent placement in the right coronary artery. Conclusion: Despite the recent advances in drug-eluting stents design, there remains a potential of stent fracture especially when a long drug-eluting stents is implanted in a tortuous vessel and is exposed to torsion forces at the hinge points.
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Mehrotra et al. (2017) conducted a case report in Unstable angina and coronary stent fracture (n=1). Zotarolimus-eluting stent was evaluated. A zotarolimus-eluting stent implanted in a tortuous right coronary artery resulted in a very delayed Type V stent fracture four years later, presenting as unstable angina.
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