Cor Vasa 2013, 55(2):e147-e150 | DOI: 10.1016/j.crvasa.2012.12.006

Stent thrombosis due to stent fracture in heavily calcified right coronary artery

Zoltán Ruzsa^*, György Szabó, Zoltán Jambrik, Balázs Berta, Levente Molnár, István Édes, Béla Merkely

Heart Center, Semmelweis University, Budapest, Hungary

Coronary stent fracture is an often unrecognized cause of target vessel failure, however, it has been reported more frequently in the drug-eluting stent era. Clinical presentation of stent fracture may range from benign in-stent restenosis to potentially fatal acute stent thrombosis. Interventional treatment of stent thrombosis can be carried out by high pressure balloon dilatation or second stent implantation into the stented segment after thrombus aspiration. Intravascular ultrasound is mandatory in order to exclude mechanical problems in the background of the stent thrombosis and to achieve good final stent apposition and expansion. We report on a stent fracture induced stent thrombosis occurring in a highly calcified proximal right coronary artery. (Treated previously with rotational atherectomy in the middle part, but not in the aorto-ostial location.) Our case emphasizes the importance of opitimal plaque modification with rotational atherectomy in a calcified aorto-ostial segment of right coronary artery to prevent long term complications such as stent thrombosis or restenosis due to stent fracture.

Keywords: Intravascular ultrasound; Rotational atherectomy; Stent fracture; Stent thrombosis

Received: October 30, 2012; Accepted: December 14, 2012; Published: April 1, 2013  Show citation