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Intracoronary Imaging of a Synergy Megatron Stent Fracture in Ostial Right Coronary Artery
Case Presentation
J INVASIVE CARDIOL 2021;33(8):E674-E675.
Key words: coronary imaging, optical coherence tomography, stent fracture
A 77-year-old male patient was admitted for non-ST segment elevation myocardial infarction (NSTEMI). Coronary angiography (CAG) showed diffusely narrowed left anterior descending and circumflex arteries, and a severely calcified ostial stenosis in the right coronary artery (RCA). After predilation, a 3.5 x 15 mm everolimus-eluting stent (Synergy Megatron, Boston Scientific) was deployed in the RCA, achieving optimal angiographic result, without complications.
Three months later, the patient was readmitted for NSTEMI. CAG revealed a complete separation of 2 stent segments, indicating a stent fracture (Figure 1 and Video 1). Intracoronary optical coherence tomography (OCT) showed intraluminal non-endothelized strut protrusion at the fracture frame, and ostial underexpansion due to severe concentric calcification (Figure 2 and Video 2). High-pressure dilation was performed (3.0 x 15 mm non-compliant balloon) followed by coronary lithoplasty with a 4.0 mm Shockwave balloon (Shockwave Medical) in the ostial underexpansion. Finally, a 4.0 x 23 mm everolimus-eluting stent was deployed, covering the fracture and stent edges, achieving a good result by angiography and OCT (Videos 3 and 4).
The Synergy Megatron stent confers enhanced axial and radial forces, which makes it an ideal choice for ostial and calcified lesions. However, in this case, the stent fractured. The mechanical stress due to severe calcification at the ostium, followed by a swinging segment, probably caused hinge effect and led to a stent fracture (Figure 2C). The fluoroscopy and stent-enhancing techniques suggest and could confirm the diagnosis, but intracoronary imaging is mandatory for anatomy characterization in order to decide treatment and optimize the result.
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Affiliations and Disclosures
From the 1Cardiology Department, Hospital Clínico Universitario de Valencia. Valencia. Spain; 2Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; 3Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; and 4School of Medicine, University of Valencia, Valencia, Spain.
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.
Manuscript accepted March 30, 2021.
The authors report patient consent for the images used herein.
Address for correspondence: Sergio García-Blas, MD, PhD, Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain, Avda, Blasco Ibáñez 17, 46010 Valencia-Spain. Email: sergiogarciablas@gmail.com
