Stent Fracture Immediately after Placement of PROMUS Element(R) Stents to a Severely Tortuous Right Coronary Artery

[ABSTRACT] A 47-year-old man with familial hypercholesterolemia and multivessel coronary disease was treated to alleviate a narrowing of the severely tortuous mid-portion of the right coronary artery. Platinum-chromium everolimus-eluting stents (PROMUS Element(R) stents) were placed under the guidance of intravascular ultrasonography, overlapping with a total stent length of 70 mm. However, immediately after the stents were placed, disruption and tear stent fractures were detected with angiography and intravascular ultrasonographic assessment, which showed a lack of circumferential and partial stent struts. One month later, the StentBoost imaging enhancement technique clearly showed stent fracture. After 1 year angiography showed no in-stent restenosis or avulsion stent fracture, a more complex stent fracture. After 2 years no clinical target vessel failure had occurred. Thus, this case provides direct evidence of stent fracture without a more complex stent fracture or symptomatic stent failure when everolimus-eluting stents are placed in the severely tortuous mid-portion of the right coronary artery.