Author + information
- Received April 23, 2012
- Revision received July 23, 2012
- Accepted August 2, 2012
- Published online February 1, 2013.
- David Pesenti Rossi, MD⁎ (, )
- Nicolas Baron, MD,
- Jean-Louis Georges, MD and
- Bernard Livarek, MD
- ↵⁎Reprint requests and correspondence:
Dr. David Pesenti Rossi, Department of Cardiology, Versailles Hospital, 177, Rue de Versailles, 78150 Le Chesnay, France
A 77-year-old man was admitted with unstable angina. He had a history of 2-vessel coronary artery bypass grafting and percutaneous coronary intervention of each anastomosis. The proximal anastomosis of the marginal branch (circumflex) bypass grafting was directly stented with a TITAN-2 3.5 × 19-mm bare-metal stent (BMS) (Hexacath, Paris, France), 2 months before.
The new angiography showed severe in-stent restenosis of the recently implanted BMS. In this case of aortic stent protrusion, repeat catheterization of the ostium was difficult. Moreover, the marginal bypass was located at the level of the aortic arch, and the probe launcher was positioned without good support and was not selective. After the first inflation with a SAPPHIRE 3.0 × 20 mm balloon (OrbusNeich, Wanchai, Hong Kong) to 16 atm, a stent fracture was suspected and confirmed by stent boost imaging, showing incomplete stent fracture (Fig. 1). A drug-eluting stent (DES) was implanted at the proximal bypass with aortic protrusion and an angiographically adequate result (Figs. 2 and 3).⇓⇓
The most likely mechanism of this fracture is balloon inflation through a stent strut. Multislice computed tomography (MSCT) revealed the DES position with aortic protrusion and a slight underexpansion, and confirmed the BMS fracture with a proximal edge positioned against the aortic wall and still attached to the other side (Figs. 4 and 5,⇓Online Video 1). The patient remained asymptomatic at 6-month follow-up.
In stent follow-up, stent fracture can be easily recognized by MSCT (1), but is hardly recognized by coronary angiography (2,3). To our knowledge, this is the first case of an intra-aortic stent fracture detected by stent boost imaging (4), which allows the enhancement of the radiological edge of the stent. In the case of restenosis and aortic stent protrusion, intravascular ultrasound guidance may have been useful to assess the guidewire position.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 23, 2012.
- Revision received July 23, 2012.
- Accepted August 2, 2012.
- American College of Cardiology Foundation
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