Author + information
- Received September 28, 2017
- Revision received October 17, 2017
- Accepted October 24, 2017
- Published online February 5, 2018.
- Nilesh Pareek, MA, MBBSa,
- Athanasios Kosovitsas, MDa,
- Michael Rubens, MBBSa,b and
- Ranil de Silva, MBBS, PhDa,b,∗ ()
- aRoyal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- bNational Heart and Lung Institute, Imperial College, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Ranil de Silva, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom.
A 74-year-old woman with prior coronary artery bypass grafting presented with CCS (Canadian Cardiovascular Society) class III angina and underwent disobliteration of a circumflex coronary artery occlusion (Figure 1). Seven months later, she developed a recurrence of effort angina. Repeat coronary imaging confirmed an in-stent occlusion secondary to fracture with the appearance of complete arterial disconnection on retrograde injections. Computed tomography (CT) coronary angiography revealed 2 distinct stent fractures (SF) within the distally implanted stent (Figure 2, Online Videos 1 and 2). There are several angiographic classifications for SF, the most common being the Nakazawa criteria (Table 1) (1). In this case, the proximal SF involves ≥2 struts with deformation (Type III), and the distal fracture involves multiple struts with complete acquired transection of the stent with a gap (Type V) (Figure 2, Online Videos 1 and 2). The early development of 2 distinct forms of SF within the same drug-eluting stent implicates chronic traction from the vein graft at the anastomosis as the primary mechanism. Vein graft anastomosis sites should be considered as a risk factor for SF.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 28, 2017.
- Revision received October 17, 2017.
- Accepted October 24, 2017.
- 2018 American College of Cardiology Foundation