Coronary artery stent fracture with in-stent restenosis and aneurysm formation: diagnosis and successful treatment with graft stent implantation.

摘要

We present a case of a 62 year old female with history of hypertension and high cholesterol levels who was admitted for cardiac catheterisation due to positive stress test consistent with anteroseptal ischaemia. One year earlier she had undergone percutaneous coronary intervention (PCI) with placement of two sirolimus eluting stents (SES) inproxymal (Cypher 3,0/33) and medial (Cypher 2,5/28) segment of the LAD (Figs. 1 and 2), with high pressure postdilatation with NC baloons (3,5/15 and 3,0/21). Second SES was placed because of coronary artery dissection at distal part of first stent.Five months after, she underwent planned PCI of the right coronary artery (2 bare metal stents). During the same procedure, focal in-stent restenosis was verified in the mid-LAD (Fig. 3) and patient was scheduled for re-PCI 3 weeks later. After discharge she was asymptomatic and refused to undergo another PCI. Eight months later patient still had no chest pain but her stress ECG showed clear signs of anteroseptal ischaemia. This time she consented to re-PCI.