Stent fracture, an incidental finding or a significant marker of clinical in-stent restenosis?

被引:80
作者
Shaikh, Fareed [1 ]
Maddikunta, Rajesh [1 ]
Djelmami-Hani, Mohamed [1 ]
Solis, Joaquin [1 ]
Allaqaband, Suhail [1 ]
Bajwa, Tanvir [1 ]
机构
[1] Univ Wisconsin, Sch Med & Publ Hlth, Auro Sinai Aurora St Lukes Med Ctr, Cardiovasc Dis Sect, Milwaukee, WI 53201 USA
关键词
drug-eluting stents; stent fracture; sirolimus-eluting stents; paclitaxol-eluting stents;
D O I
10.1002/ccd.21371
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The predictors and clinical significance for stent fracture (SF) in drug-eluting stents (DES) remain unknown. We identified procedural factors leading to SF and its clinical consequences in DES. Methods: Percutaneous coronary interventions were performed on 3,920 patients with DES over 12 months. In-stent restenosis (ISR) of DES was observed in 188 cases with 121 cases (64.4%) receiving a sirolimus-eluting stent (SES) and 67 (35.6%) a paclitaxol-eluting stent (PES). Results: SF was identified in 35 (18.6%) of the 188 cases. The 35 cases were then compared with 153 cases of ISR without angiographic evidence of SE SF was identified in 29 (23.9%) SES compared with 6 (9.0%) in PES (P < 0.05). With univariate analysis, additional factors associated with SF included longer mean stented segment length, male gender, overlapping stents, vessel segment angulation > 75 degrees, and more stents (all P < 0.05). With multivariate adjustment, three factors, i.e., stenting on a bend > 75 degrees (OR = 13.85 95%CI 3.7 to 51; P < 0.001), SES (OR = 4.1, 95%CI 1.3 to 13.4; P < 0.018) and overlapping stented segments (OR = 3.9, 95%CI 1.1 to 14.1; P < 0.041) were statistically significant independent predictors of SF while larger stent diameter was protective (OR = 0.14, 95%CI 0.04 to 0.70; P < 0.017). Conclusion: SF proved to be associated with angiographically-documented clinical ISR. Although the exact mechanism is unknown, factors that appear to play a negative role in SF include vessel tortuosity, use of SES and overlapping stents. Larger stent diameter was protective. Further studies are needed to better define the factors important in the mechanism of SF. (c) 2008wiley-Liss, Inc.
引用
收藏
页码:614 / 618
页数:5
相关论文
共 19 条
[1]   Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation [J].
Aoki, Jiro ;
Nakazawa, Gaku ;
Tanabe, Kengo ;
Hoye, Angela ;
Yamamoto, Hirosada ;
Nakayama, Tomohiro ;
Onuma, Yoshinobu ;
Higashikuni, Yasutomi ;
Otsuki, Syuji ;
Yagishita, Atsuhiko ;
Yachi, Sen ;
Nakajima, Hiroyoshi ;
Hara, Kazuhiro .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2007, 69 (03) :380-386
[2]   Coronary-stent fracture [J].
Chowdhury, PS ;
Ramos, RG .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (08) :581-581
[3]  
*DA, 2002, NIROYAL COR STENT RA
[4]   A RANDOMIZED COMPARISON OF CORONARY-STENT PLACEMENT AND BALLOON ANGIOPLASTY IN THE TREATMENT OF CORONARY-ARTERY DISEASE [J].
FISCHMAN, DL ;
LEON, MB ;
BAIM, DS ;
SCHATZ, RA ;
SAVAGE, MP ;
PENN, I ;
DETRE, K ;
VELTRI, L ;
RICCI, D ;
NOBUYOSHI, M ;
CLEMAN, M ;
HEUSER, R ;
ALMOND, D ;
TEIRSTEIN, PS ;
FISH, RD ;
COLOMBO, A ;
BRINKER, J ;
MOSES, J ;
SHAKNOVICH, A ;
HIRSHFELD, J ;
BAILEY, S ;
ELLIS, S ;
RAKE, R ;
GOLDBERG, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (08) :496-501
[5]   High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty [J].
Gray, BH ;
Sullivan, TM ;
Childs, MB ;
Young, JR ;
Olin, JW .
JOURNAL OF VASCULAR SURGERY, 1997, 25 (01) :74-83
[6]   Late incomplete lesion coverage following Cypher stent deployment for diffuse right coronary artery stenosis [J].
Halkin, A ;
Carlier, S ;
Leon, MB .
HEART, 2004, 90 (08) :e45
[7]   Effect of exercise on frequency of stent fracture in the superficial femoral artery [J].
Iida, Osamu ;
Nanto, Shinsuke ;
Uematsu, Masaaki ;
Morozumi, Takakazu ;
Kotani, Jun-ichi ;
Awata, Masaki ;
Onishi, Toshinari ;
Ito, Noriaki ;
Sera, Fusako ;
Minamiguchi, Hitoshi ;
Akahori, Hirokuni ;
Nagata, Seiki .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 98 (02) :272-274
[8]   Limitations of percutaneous transluminal angioplasty and stenting for the treatment of disease of the superficial femoral and popliteal arteries [J].
Laird, JR .
JOURNAL OF ENDOVASCULAR THERAPY, 2006, 13 :30-40
[9]   Stent fracture associated with drug-eluting stents: Clinical characteristics and implications [J].
Lee, Michael S. ;
Jurewitz, Daniel ;
Aragon, Joseph ;
Forrester, James ;
Makkar, Raj R. ;
Kar, Saibal .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2007, 69 (03) :387-394
[10]   Three-dimensional analysis of in vivo coronary stent - coronary artery interactions [J].
Liao, R ;
Green, NE ;
Chen, SYJ ;
Messenger, JC ;
Hansgen, AR ;
Groves, BM ;
Carroll, JD .
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, 2004, 20 (04) :305-313