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Clinical Images
Unstable Angina Due to Stent Fracture
Emmanouil S. Brilakis, MD, Calin Maniu, MD, Michael Wahl, MD, Gregory Barsness, MD
September 2004
Case Report. A 78-year-old woman who had undergone coronary artery bypass grafting eight years earlier presented with unstable angina. At coronary angiography, an aorto-ostial lesion was found in a saphenous vein graft to the right posterior descending artery, and this lesion was successfully treated with a 3.5 mm x 13 mm BX Velocity stent (Cordis Corporation, Miami Lakes, Florida), with inflations up to 18 atm. The middle portion of the stent remained mildly under-expanded (Figure 1). She had complete resolution of her angina for approximately one month, but then the angina recurred. Repeat coronary angiography demonstrated a fracture in the mid-portion of the stent (Figure 2) with recurrence of a significant stenosis at the fracture site. Both stent fragments were crossed with a wire and a second 13 mm stent was deployed across both fragments of the previously placed stent with a good angiographic result (Figure 3) and subsequent resolution of the angina.
Conclusion. In-stent restenosis can, on rare occasions, be due to stent fracture.
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