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DES Stent Fractures Linked to Worse Outcome
By TCT Daily Staff
As DES use in more complex lesions is increasing, it is important to understand the prevalence of fracture in these stents, as well as lesion type and associated clinical outcomes, according to Jeffrey J. Popma, MD, of St. Elizabeth’s Medical Center in Boston.
Initially recognized in superficial femoral arteries, stent fractures can be difficult to detect in the coronary tree, Popma said.
Causes of strut fracture are multifactorial. Regarding design, rigid stents appear predisposed to fracture more than open-cell designs. Among procedural issues, stent overexpansion and overlap have proven most deleterious. Anatomically, stent fracture is more common in vessels that have calcium nodules, are highly angulated, and are subject to high stress from cardiac motion.
Although there is a very low incidence of stent fracture with Cypher (Cordis/Johnson & Johnson) in simpler "workhorse" lesions, clinical reports point to higher rates of strut fracture in more complex patient subsets with this stent, Popma said.
In the SIRIUS study, angiographically proven stent fracture was linked to more severe fracture and longer stent length. In addition, fractures were more common with ostial location, longer lesions, angulation, proximal tortuosity, extensive vessel calcification and total occlusion. Importantly, in the Taxus analysis, patients with strut fracture had higher rates of binary restenosis (40% vs. 16.4% in patients without stent fracture; P=0.07). This was associated with worse clinical outcome, in particular, higher rates of TLR and stent thrombosis.
In a related presentation, Adnan Chhatriwalla, MD, of the Cleveland Clinic, provided results of a literature and FDA database review of 37 reports involving 202 DES fractures in 196 patients between January 1, 2003, and April 30, 2008. He concluded that DES stent fracture is likely underrecognized and is associated with stent thrombosis, unstable angina and MI.
DES断裂可导致不良后果
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