Minardi Giovanni, Pino Paolo G, Nazzaro Marco Stefano, Pavaci Herribert, Sordi Martina, Greco Cesare, Gaudio Carlo
Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
J Med Case Rep. 2009 Nov 24;3:9296. doi: 10.1186/1752-1947-3-9296.
A bare-metal stent fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome is a rare clinical event that, to the best of our knowledge, has previously not been reported. A stent fracture is a rare complication arising from percutaneous coronary intervention.
We present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation.
A coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction) in a native coronary artery. It was diagnosed angiographically and treated early and effectively.
裸金属支架断裂作为急性冠状动脉血栓形成及随后急性冠状动脉综合征的病因是一种罕见的临床事件，据我们所知，此前尚未见报道。支架断裂是经皮冠状动脉介入治疗引发的一种罕见并发症。
据我们所知，我们报告了首例有记录的晚期裸金属支架断裂并伴有自身冠状动脉血栓形成后发生ST段抬高型心肌梗死的患者。该患者为一名51岁的白种男性，经直接经皮冠状动脉介入治疗及植入新支架后获得成功治疗。
冠状动脉支架断裂是一种罕见的并发症，在使用药物洗脱支架或裸金属支架的静脉旁路移植血管中已有描述。支架断裂在冠状动脉中很少发生。鉴于支架断裂的表现不具特异性，它也是一种容易被漏诊的并发症。患者可能表现为非特异性的心绞痛症状。由于再狭窄或支架内血栓形成，或两者兼而有之，心绞痛可能为稳定型或不稳定型。我们的病例展示了裸金属支架在自身冠状动脉中发生断裂（突发冠状动脉血栓形成及随后的心肌梗死）的最严重后果。通过血管造影得以诊断，并得到了早期有效的治疗。
