| 나승운, Lin Wang,박지영, Kanhaiya L. Poddar, Sureshkumar Ramasamy, 최병걸, 김지박,신승용, 최운정, 최철웅, 임홍의, 김진원, 김응주, 박창규, 서홍석, 오동주 |
Background：Recently, stent fracture (SF) has been shown to be associated with an increased risk of in-stent restenosis (ISR), even in the drug-eluting stent (DES) era. There are very limited data regarding the outcomes of patients (pts) undergoing repeat percutaneous coronary intervention (PCI) for angiographically documented significant ISR associated with SF.
Method: The study population consisted of 2080 consecutive pts (3384 lesions) underwent PCI from April 2006 to February 2009, among which 9 pts (10 SFs) were angiographically detected. We investigated the mid-term outcomes of the pts after PCI for SF. Results: Out of 3384 lesions treated with PCI with DES, 3294 (97.3%) were implanted with Cypher (916), Taxus (1214), Endeavor (511) and other type of stents. A total 1481 (71.2%) pts finished 6-month clinical follow up and 1453 (69.9%) pts underwent angiographic follow-up. The angiographically documented SF was in 0.69% (10/1453). The mean age of SF pts was 67.8±5.5 years and 5 pts (55.5%) were male. The duration from the stent implantation to the SF detection was 10.0±5.3 months. The fractured stents detected by angiography were Cypher (7/456, 1.53%), Taxus (2/607, 0.33%) and Endeavor 1/233, 0.43%) stents (Cypher vs non-Cypher=1.5% vs 0.4%, p=0.021). Predilection SF sites were in LAD (50%, proximal=1, mid=4), LCX (30%, proximal=1, mid=1, distal=1) and RCA (20%, proximal=1, distal=1). The sizes of the fractured stents were 2.67±0.20 (2.25-2.75) mm in diameter and 25.0±6.7 (15-33) mm in length. Complete SF was dound in 50%. Six SFs (5 Cypher, 1 Taxus) were associated with significant ISR and underwent PCI with different DESs (5 Taxus, 1 Xience). The rest of 4 SF without ISR were not treated. Within 7.8±6.5 (3-21) months follow-up duration, there was no recurrent SF, death, myocardial infarction, however, 1 treated SF (16.7%, 1/6) needed repeat balloon angioplasty due to recurrent ISR.Conclusion: SF in the DES era was not frequent but tends to occur in small vessels, long lesions and associated with Cypher stent implantation. More than half of SF was associated with significant ISR and underwent repeat PCI with different DES, but 1/6 of treated SFs needed repeat PCI, suggesting careful monitoring would be necessary in this particular subset of pts
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