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Stent fracture in Right Coronary Artery (RCA)

Patient History

  • 75 year old female
  • Recurrent angina at low level exercise
  • Attempted stent placement 4 months earlier but stent would not pass
  • Settled for plain old balloon angioplasty (POBA)
  • 4 months later, severe restenosis after POBA

Baseline Angiography

Baseline angiography post–POBA from 4 months earlier

Baseline POBA result from 4 months earlier
Baseline Diagnostic angiography 4 months after POBA

Post-PCI Angiography (1)

  • A HI-TORQUE WHISPER® Guide Wire1 within Turnpike® Catheter2 was used to cross lesion. The HI-TORQUE WHISPER® Guide Wire1 wire does not straighten tortuosity.  Turnpike® Catheter2 follows HI-TORQUE WHISPER® Guide Wire1 wire with modest straightening of vessel.
  • HI-TORQUE WHISPER® Guide Wire1 exchanged for a HI-TORQUE WIGGLE® Guide Wire3. Turnpike® Catheter2 is withdrawn and HI-TORQUE WHISPER® Guide Wire1 straightens vessel. Results in severe pseudo spasm.
  • A decision to stent the entire region, including pseudo spasm. The long stent passes easily.  Stent is deployed.
  • Post-PCI, note the odd looking focal narrowing in the middle of the stent.
Post-PCI angiography (1)

Post-PCI Angiography (2)

This is followed by dilation of narrowing in the middle of the stent and removal of guide wire. Not much change, but focal narrowing persists.

Post-PCI angiography (2)

Post-PCI HD IVUS

HD IVUS shows area of “absent” stent struts from 11:00 to 3:00 position (stent fracture)

Post-PCI HD IVUS

Post-PCI Angiography (3)

  • Pass and deploy stent within stent
  • Great result but now we have moved the kink downstream
  • Stent and kink re-crossed easily with folded HI-TORQUE BALANCED MIDDLEWEIGHT® (BMW) Guide Wire4
  • Wire alone straightens out kink. 3rd stent deployed at distal stent margin.
Post-PCI angiography (3) after 2nd stent
Post-PCI angiography (3) after 3rd stent

Conclusion

HD IVUS revealed the stent fracture and guided the treatment option

Baseline Angiography

Baseline POBA result from 4 months earlier

Baseline Angiography

Baseline Diagnostic angiography 4 months after POBA

Post-PCI Angiography (1)

Post-PCI angiography (1)

Post-PCI Angiography (2)

Post-PCI angiography (2)

Post-PCI HD IVUS

Post-PCI HD IVUS

Post-PCI Angiography (3)

Post-PCI angiography (3) after 2nd stent

Post-PCI Angiography (3)

Post-PCI angiography (3) after 3rd stent

References
  1. HI-TORQUE WHISPER® is a trademark of Abbott Vascular Inc.
  2. Turnpike® is a trademark of Vascular Solutions Inc.
  3. HI-TORQUE WIGGLE® is a trademark of Abbott Vascular Inc.
  4. HI-TORQUE BALANCED MIDDLEWEIGHT® is a trademark of Abbott Vascular Inc.