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 Turnpike® Catheter2 is withdrawn and HI-TORQUE WHISPER® Guide Wire1 straightens vessel.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.


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. 3rd stent deployed at distal stent margin.


HD IVUS revealed the stent fracture and guided the treatment option


  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.
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