3D Optical Coherence Tomography Reveals Fractured Coronary Stent as Cause of Acute Myocardial Infarction

J INVASIVE CARDIOL 2019;31(9):E278.

Key words: cardiac imaging, complications, optical coherence tomography, stent fracture

A 61-year-old male presented with anterior ST-segment elevation. Emergency coronary angiography demonstrated complete occlusion of the left anterior descending (LAD) coronary artery, which was treated with primary percutaneous intervention. Following predilation, a 2.5 mm x 38 mm Xience V drug-eluting stent (Abbott Vascular) was implanted. Due to coronary calcification, the distal portion of the stent was repeatedly postdilated with a 3 mm x 15 mm non-compliant balloon (NC Trek; Abbott Vascular) to ensure adequate stent expansion. The final angiographic result was good.

The patient was readmitted 2 days later with recurrence of chest pain and anterior ST-segment elevation. Repeat coronary angiography revealed occlusion of the LAD coronary artery (Figure 1A) within the previously implanted stent. Following aspiration of large quantities of thrombus, there remained a filling defect on angiography (Figure 1B) that persisted despite repeat balloon inflations.

Three-dimensional optical coherence tomography (Abbott Vascular) revealed extensive fracture and distortion of the struts in the distal portion of the stent, presumably caused by the aggressive postdilation at the time of implantation. This was managed successfully with the insertion of a new coronary stent inside the damaged stent segment.

From Morriston Cardiac Centre, Swansea, United Kingdom.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 22, 2019.

Address for correspondence: Daniel R. Obaid, PhD, MA(Cantab), MRCP(UK), Morriston Cardiac Centre, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea, SA6 6NL United Kingdom. Email: Daniel.R.Obaid@wales.nhs.uk