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European Heart Journal Advance Access originally published online on October 24, 2005
European Heart Journal 2006 27(12):1389; doi:10.1093/eurheartj/ehi542
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sirolimus-eluting stent fracture with thrombus, visualization by optical coherence tomography

Junya Shite*, Daisuke Matsumoto and Mitsuhiro Yokoyama

Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan

* Corresponding author. E-mail address: shite{at}med.kobe-u.ac.jp

A 72-year-old man, with a history of old myocardial infarction, was admitted for angiography. The angiogram showed a 99% angulated stenosis in the right coronary artery (Panel A). Following implantation of two sirolimus-eluting stents (SES) (CypherTM 3.5x23 mm, 3.5x18 mm) at the culprit lesion and dilatation with a 4 mm balloon at 20 atm, the angulated segment of the artery straightened (Panel B). Intravascular ultrasound demonstrated the well-apposed SES with no stent fracture or plaque protrusion at the angulated site. Three months after cessation of ticlopidine with continued use of aspirin, an angiogram at 6-month follow-up showed a re-angulated coronary artery with contrast filling defect (Panel C). At this site, optical coherence tomography (LightLabTM) revealed the fractured stent at six o'clock with thrombus adhesion (Panel D).

Coronary angiographies before (Panel A) and after (Panel B) SES implantation. A well-dilated and straightened coronary was achieved by stenting. Six-month follow-up angiogram (Panel C) showed a re-angulated coronary with contrast filling defect (arrow). Optical coherence tomography images at angulated coronary site show a fractured stent with attached thrombus (Panel D).

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D. Matsumoto, J. Shite, T. Shinke, H. Otake, Y. Tanino, D. Ogasawara, T. Sawada, O. L. Paredes, K.-i. Hirata, and M. Yokoyama
Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography
Eur. Heart J., April 2, 2007; 28(8): 961 - 967.
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