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 Turnpike® Catheter2 is withdrawn and HI-TORQUE WHISPER® Guide Wire1 straightens vessel.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
References
- HI-TORQUE WHISPER® is a trademark of Abbott Vascular Inc.
- Turnpike® is a trademark of Vascular Solutions Inc.
- HI-TORQUE WIGGLE® is a trademark of Abbott Vascular Inc.
- HI-TORQUE BALANCED MIDDLEWEIGHT® is a trademark of Abbott Vascular Inc.
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