Stent fracture has been suggested as one of the leading risk factors for thrombosis and in-stent restenosis in patients with an intracoronary drug-eluting stent. Contributing factors are stent in the right coronary artery, excessive tortuosity of the vessel, angulation or change of angulation after stent implantation, overlapping stents and conformability of the stent.
In the case reported, a 61-year-old man, with a history of dyslipidaemia and hypertension, was referred to our institution for incapacitating effort angina despite maximal medical treatment. Left ventricular function was normal. The coronary angiography revealed left dominant circulation with severe lesions of the left descending artery (LAD) and occlusion of the second obtuse marginale ( Fig. 1 , Video 1 ). The distal LAD was revascularized with a 2.5 × 18 mm Cypher stent, and the mid and proximal LAD with 2.75 × 23 mm and 3.0 × 28 mm Cypher stents (short overlapping) ( Fig. 2 A and B , Video 2 ). At 1 year, the patient described increasing effort angina with anterior, septal and apical myocardial perfusion deficit on dipyridamole stress perfusion cardiovascular magnetic resonance, without myocardial infarction ( Fig. 3 ). Coronary angiography showed grade 2 TIMI flow in the LAD, with very tight focal restenosis at the mid and final part of the 2.75 × 23 mm Cypher stent and at the proximal and mid part of the 2.5 × 18 mm Cypher stent. There was a complete stent fracture with contrast extravasation in the second stent and another fracture without contrast extravasation in the third stent ( Fig. 2 C and D, Video 3 ). The fractures appeared at the junction of the epicardial and intramyocardial courses of the LAD without compressive muscular bridge.
