Planchat Arnaud, Musayeb Yazan, Glauser Frédéric, Iglesias Juan F, Roffi Marco
Department of Medicine, Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
Department of Medicine, Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
JACC Case Rep. 2025 May 28;30(12):103423. doi: 10.1016/j.jaccas.2025.103423.
This case presents the novel use of a peripheral self-expanding nitinol stent to treat recurrent coronary stent fractures (SFs) in a saphenous vein graft (SVG) previously treated with 2 layers of drug-eluting stents in an 84-year-old man. Angiographic follow-up at 16 months showed an intact stent. SF is a rare complication, in this case likely owing to shear mechanical forces between the SVG and the ascending aorta, in addition to the extrinsic compression of vessel calcification. Independent of the mechanisms, if the first metallic (ie, stainless steel or cobalt-chromium) balloon-expandable coronary stent does fracture, the second one is likely to fail as well. The implantation of a peripheral self-expanding nitinol stents in this patient overcame those mechanical forces. This may represent a novel approach to treat coronary SF, especially in the SVG. Additionally, this case highlights the importance of intravascular imaging in assessing lesion characteristics and guiding stent implantation, potentially preventing SF.
本病例介绍了一位84岁男性患者使用外周自膨式镍钛合金支架治疗隐静脉搭桥术（SVG）中复发性冠状动脉支架骨折（SFs）的新方法，该SVG此前已植入两层药物洗脱支架。16个月后的血管造影随访显示支架完好无损。SF是一种罕见的并发症，在本病例中，可能是由于SVG与升主动脉之间的剪切机械力，以及血管钙化的外在压迫所致。无论其机制如何，如果第一个金属（即不锈钢或钴铬合金）球囊扩张式冠状动脉支架发生骨折，第二个支架也很可能会失效。在该患者中植入外周自膨式镍钛合金支架克服了这些机械力。这可能代表了一种治疗冠状动脉SF的新方法，尤其是在SVG中。此外，本病例强调了血管内成像在评估病变特征和指导支架植入方面的重要性，有可能预防SF。
