PMID- 19909872
OWN - NLM
STAT- MEDLINE
DCOM- 20091215
LR  - 20220310
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 54
IP  - 21
DP  - 2009 Nov 17
TI  - Incidence and predictors of drug-eluting stent fracture in human coronary artery 
      a pathologic analysis.
PG  - 1924-31
LID - 10.1016/j.jacc.2009.05.075 [doi]
AB  - OBJECTIVES: The aim of this study was to perform pathologic assessment on stent 
      fracture. BACKGROUND: Clinically, stent fracture has been reported in 1% to 2% of 
      patients after drug-eluting stent (DES) implantation. METHODS: High-contrast 
      film-based radiographs of 177 consecutive lesions from the CVPath DES autopsy 
      registry were reviewed. Stent fracture was graded as I (single-strut fracture), 
      II (> or =2 struts), III (> or =2 struts with deformation), IV (with transection 
      without gap), and V (with transection causing gap in stent segment). The 
      incidence of adverse pathologic findings (thrombosis and restenosis) was assessed 
      histologically. RESULTS: Stent fracture was documented in 51 lesions (29%; grade 
      I = 10, II = 14, III = 12, IV = 6, and V = 9). Lesions with stent fracture had 
      longer duration after implantation (172 days [interquartile range (IQR) 31 to 630 
      days] vs. 44 days [IQR 7 to 270 days], p = 0.004), a higher rate of Cypher 
      (Cordis Corp., Miami Lakes, Florida) stent usage (63% vs. 36%, p = 0.001), longer 
      stent length (30.0 mm [IQR 22.0 to 40.0 mm] vs. 20.0 mm [IQR 14.0 to 27.3 mm], p 
      < 0.0001), and a higher rate of overlapping stents (45% vs. 22%, p = 0.003). 
      Although fracture with grade I to IV did not have significant impact on the 
      occurrence of adverse pathologic findings such as thrombosis and restenosis, 67% 
      of the grade V fracture lesions were associated with adverse pathologic findings 
      at fracture sites. Longer stent length, use of Cypher, and longer duration of 
      implant were identified as independent risk factors of stent fracture by logistic 
      regression analysis. CONCLUSIONS: The incidence of stent fracture was 29% lesions 
      at autopsy, which is much higher than clinically reported. A high rate of adverse 
      pathologic findings was observed in lesions with grade V stent fracture, whereas 
      fracture with grade I to IV did not have a significant impact on the pathological 
      outcome.
FAU - Nakazawa, Gaku
AU  - Nakazawa G
AD  - CVPath Institute, Inc., Gaithersburg, Maryland, USA.
FAU - Finn, Aloke V
AU  - Finn AV
FAU - Vorpahl, Marc
AU  - Vorpahl M
FAU - Ladich, Elena
AU  - Ladich E
FAU - Kutys, Robert
AU  - Kutys R
FAU - Balazs, Isidora
AU  - Balazs I
FAU - Kolodgie, Frank D
AU  - Kolodgie FD
FAU - Virmani, Renu
AU  - Virmani R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Autopsy
MH  - Coronary Stenosis/diagnosis/*surgery
MH  - Coronary Vessels/*pathology
MH  - *Drug-Eluting Stents
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*epidemiology/pathology
MH  - Prognosis
MH  - Prosthesis Failure
MH  - United States/epidemiology
EDAT- 2009/11/17 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/11/14 06:00
PHST- 2008/12/08 00:00 [received]
PHST- 2009/04/23 00:00 [revised]
PHST- 2009/05/05 00:00 [accepted]
PHST- 2009/11/14 06:00 [entrez]
PHST- 2009/11/17 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - S0735-1097(09)02846-0 [pii]
AID - 10.1016/j.jacc.2009.05.075 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2009 Nov 17;54(21):1924-31. doi: 10.1016/j.jacc.2009.05.075.