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Stenting make vessel not only expanded but also elongated:Insight from Stent Fracture
국민건강보험공단 일산병원 심혈관센터
오성진, 전상운,윤세정,김병극,전동운,양주영
Background:Despite a few millimeters of length, the origin of the gap between fractured stent segments is uncertain. We hypothesized that stenting procedure shortened the vessel length containing the lesion and stent fracture result in restoration of the original vessel length.Method:We analyzed 26 stent fracture cases. First, post-intervention study was reviewed to identify proximal and distal landmarks (usually side branch) located outside stent edges. Then, pre-intervention and follow up study were reviewed to identify the corresponding landmarks. We measured the length between landmarks(LBL) (pre, post, and follow up) and stent edges(LBSE) (post and follow up) and calculated the length between stent edge and nearby landmark(LBSEL, proximal and distal). We also checked angle between proximal and distal segments at systolic phase in pre, post, and follow-up periods.Results:All 26 fractured stents were Cypher stents and located at LAD in 10 cases, LCx in 2 cases and RCA in 14 cases. Except two 28mm stents, all fractured stents were 33mm length stents. Average stent diameter was 3.2±0.3mm. After stenting, LBL was decreased significantly (49.36±8.62mm to 48.60±8.98mm, p=0.032) and was increased again after fracture ocurred (48.60±8.98mm to 49.70±8.62mm, p=0.011). LBSE was increased after stent fracture compared with post intervention (31.93±1.71mm to 33.61±2.76mm, p<0.001). Both proximal and distal LBSEL were not changed significantly at follow-up (proximal 9.07±5.63mm vs. 8.37±4.93mm; p=ns, distal 8.66±5.06mm vs. 8.51±5.09mm; p=ns). Vascular angles were increased significantly after stenting, which were returned at follow-up (61.7±22.6, 32.2±21.1, 67.2±25.6;pre, post, and follow-up, respectively). Conclusion:Coronary stenting not only expands but also shortens the length of target lesion. Fracture of stent result in restoration of original length.
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