Chung Wook-Sung, Park Chul-Soo, Seung Ki-Bae, Kim Pum-Joon, Lee Jong-Min, Koo Bon-Kwon, Jang Yang-Soo, Yang Joo-Young, Yoon Jung-Han, Kim Doo-Il, Yoon Young-Won, Park Jong-Seon, Cho Yoon-Haeng, Park Seung-Jung
Catholic University Saint Mary's Hospital, Youeuido-dong, Youngdeungpo-gu, Seoul, 150-713 Korea.
Int J Cardiol. 2008 Apr 25;125(3):325-31. doi: 10.1016/j.ijcard.2007.02.033. Epub 2007 Apr 16.
Cases of stent strut fractures (SSFs) after DES implantation have been reported, but the clinical significance is uncertain. Then we sought to define the incidence and clinical implications of SSFs developed after drug-eluting stent (DES) implantation.
We gathered SSF cases from 13 centers in Korea retrospectively. SSF was defined as angiographically visible interrupted connection of stent struts or fewer visible stent struts at the suspected site than normally looking stented area on intravascular ultrasound (IVUS). Furthermore, we classified the SSFs cases into three patterns (disruption, avulsion, and displacement) according to the interruption site and absence or presence of displacement.
Thirty-seven SSFs (2 disruption, 7 avulsion, 28 displacement) were detected in 35 lesions in 35 patients. All fractured stents were sirolimus-eluting stents (SESs). The incidence of SSFs was 0.84% and the proportion of restenosis related with SSF was 6.3% after SES implantation driven from the data of 8 centers. The average length of stent used was 49 mm, overlapping stenting was performed in 19 lesions (54%), and the average maximal angulation in the initial coronary angiography was 67 degrees . Twenty-four fractures (65%) were associated with focal in stent restenosis and 11 fractures (30%) with target lesion revascularization. No acute coronary syndrome developed.
SSF after DES implantation might be a considerable complication after DES implantation especially after SES implantation.
药物洗脱支架（DES）植入术后支架小梁骨折（SSF）的病例已有报道，但临床意义尚不确定。因此，我们试图明确药物洗脱支架植入后发生的SSF的发生率及临床意义。
我们回顾性收集了韩国13个中心的SSF病例。SSF定义为血管造影可见的支架小梁中断连接，或血管内超声（IVUS）显示可疑部位的支架小梁数目少于正常支架区域。此外，我们根据中断部位及有无移位将SSF病例分为三种类型（断裂、撕脱和移位）。
在35例患者的35个病变中检测到37例SSF（2例断裂、7例撕脱、28例移位）。所有骨折支架均为西罗莫司洗脱支架（SES）。根据8个中心的数据，SES植入后SSF的发生率为0.84%，与SSF相关的再狭窄比例为6.3%。所用支架的平均长度为49 mm，19个病变（54%）进行了重叠支架置入，初始冠状动脉造影时的平均最大成角为67度。24例骨折（65%）与支架内局灶性再狭窄相关，11例骨折（30%）与靶病变血运重建相关。未发生急性冠状动脉综合征。
DES植入后尤其是SES植入后的SSF可能是一种相当严重的并发症。
