Background: Several studies represent that stent fracture after Sirolimus-Eluting Stent (SES) implantation may be a potential cause of neointimal hyperplasia and stent thrombosis. However, long-term clinical and angiographic findings according to therapeutic modalities for the SES fracture are unknown.
Methods: A total 68 stent fractures from 47 patients who had performed SES implantation were divided into the three groups according to therapeutic modalities (no treatment, percutaneous optimal balloon angioplasty; POBA, and sent implantation) at the time of fracture detection. Therapeutic modalities were on the operator’s discretion. Group I (n=47, 28 patients) included stent fractures without treatment. Group II (n=8, 7 patients) and III (n=13, 12 patients) received POBA and another stent implantation, respectively.
Results: Mean follow-up duration from fracture detection to last visit was 770 ± 320 days. Twenty four (35.3 %) fractures were found to have restenosis at first angiographic follow-up (group I: 10.9 %, group II: 100 %, group III: 78.6 %; p< 0.01). Stent thrombosis or myocardial infarction related with stent fracture did not developed up to that time. Second angiographic follow-up was performed in 47 (69.1 %) fracture (group I: 65.2 %. group II: 75.0 %, group III: 78.6 %; p=0.66) from 31 (66.0 %) patients. The rate of second follow-up restenosis was 40.0 %, 50.0 % and 9.1 % in group I, II and III, respectively. The rate of target lesion revascularization (TLR) tended to be higher in group II (37.5% of fracture), as compared with group I (13.0%) and group III (7.1 %) (p=0.16) (Figure 1). Only 4 patients (14.3%) with 4 fractures (8.5 %) in group I had myocardial infarction, and 3 of these were related with very late stent thrombosis (Figure 2). No cardiac death occurred in all groups.
Conclusions: Although all stent fracture does not need interventional treatment, if we intend to treat stent fracture, repeated stent implantation may be better option compared with POBA considering somewhat higher rate of TLR and stent thrombosis in fracture site uncovered by stent strut.
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