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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

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 Turnpike^® Catheter² is withdrawn and HI-TORQUE WHISPER^® Guide Wire¹ straightens vessel.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 (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 HD IVUS

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

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. 3^rd stent deployed at distal stent margin.

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.