Abstract 18397: Stent Fracture is More Common in Drug Eluting Stents Than in Bare Metal Stents: Post-mortem MicroCT Analysis
Introduction: The prevalence of coronary stent fracture is uncertain. A recent autopsy series described a relatively high drug eluting stent (DES) fracture rate of 29%. We used post-mortem microCT analysis to determine if stent fracture occurs more frequently in DES than in bare metal stents (BMS).
Methods: Between April 2008 and May 2010, 205 adult patients were referred to the Dartmouth-Hitchcock Autopsy Service. Coronary stents were present in 29 patients and the hearts of 20 (69%) were pressure fixed and the coronary arteries were perfused with bismuth contrast. The stented arterial segments were resected and imaged with microCT. Three-dimensional (11–32 micron voxel) reconstructions were examined to identify stent fracture.
Results: Stent fracture was observed in 7 of 60 stents studied. No stent fracture was identified in BMS, while stent fracture was identified in 7 (20%) of DES. There were 25 BMS compared to 35 DES: 48% vs 31% were single stents, 52% vs 20% were overlapping stents and 0% vs 46% were in bifurcation lesions. The median duration from implant to death was 820 days (1–3789 days) for BMS, 163 days (0–1733 days) for all DES and 1090 days (983–1733 days) for fractured DES. Two of the 13 paclitaxel eluting stents (15%) were fractured while 5 of the 7 sirolimus eluting stents (71%) were fractured. Four fractures were located in the LCX, 2 in the RCA and 1 in the LAD. Two of the fractured stents were single stents, 2 were overlapping stents and 3 were in bifurcation lesions. Severe stent fracture resulting in stent transection was identified in a single RCA paclitaxel eluting stent and in two LCX sirolimus eluting stents (1 bifurcation and 1 overlap).
Conclusion: In this single center series, no fracture of BMS was identified while fracture was identified in 20% of DES, primarily in sirolimus eluting stents.
- © 2010 by American Heart Association, Inc.