Yamane Haruya, Kosugi Shumpei, Date Motoo, Ueda Yasunori
Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
Eur Heart J Case Rep. 2021 Jul 1;5(7):ytab246. doi: 10.1093/ehjcr/ytab246. eCollection 2021 Jul.
Stent implantation through the stent-strut of a previously implanted self-expandable stent in the superficial femoral artery (SFA) is not usually performed because the additional stent cannot dilate sufficiently. The key point to achieve sufficient expansion of an additional stent is to break the stent-strut of the previously implanted stent. However, there is no report of how to break the stent-strut.
A 72-year-old man was admitted to our hospital with acute rest pain and coldness of his left leg; he was diagnosed with acute limb ischaemia. The angiogram demonstrated a fractured stent as well as stent occlusion in the left distal SFA. The guidewire could pass only through the stent-strut because of stent fracture. Fortunately, balloon angioplasty through the stent-strut and thrombolysis achieved successful revascularization. Thereafter, an additional stent was implanted in an attempt to manage the fractured and deformed stent. To obtain sufficient expansion of the additional stent, an experimental study to examine the balloon diameter and pressure to break the stent-strut was performed. Based on the results of the experiment, the stent-strut was successfully broken, and the additional stent was expanded through the stent-strut on the second intervention.
If an additional self-expandable stent is deployed through the stent-strut directly, it would not be sufficiently dilated. The key point in such a case is to break the stent-strut of the previously implanted stent by balloon inflation before deployment of the additional stent. The experimental study examined the balloon diameter and pressure that can break the stent-strut. This information would be useful when we implant an additional stent through a stent-strut.
通常不会通过先前植入的股浅动脉（SFA）自膨式支架的支架小梁植入支架，因为额外的支架无法充分扩张。实现额外支架充分扩张的关键在于破坏先前植入支架的支架小梁。然而，尚无关于如何破坏支架小梁的报道。
一名72岁男性因左下肢急性静息痛和发凉入院；诊断为急性肢体缺血。血管造影显示左股浅动脉远端有一个断裂的支架以及支架闭塞。由于支架断裂，导丝只能穿过支架小梁。幸运的是，通过支架小梁进行球囊血管成形术和溶栓实现了成功的血管再通。此后，为处理断裂和变形的支架植入了一个额外的支架。为使额外的支架充分扩张，进行了一项实验研究以检测破坏支架小梁所需的球囊直径和压力。根据实验结果，成功破坏了支架小梁，在第二次干预时额外的支架通过支架小梁得以扩张。
如果直接通过支架小梁植入一个额外的自膨式支架，它将无法充分扩张。在这种情况下，关键在于在植入额外支架之前通过球囊充盈破坏先前植入支架的支架小梁。该实验研究检测了能够破坏支架小梁的球囊直径和压力。当我们通过支架小梁植入额外支架时，这些信息将很有用。
