Very Late Fracture of a First-Generation Drug-Eluting Stent.

BACKGROUND

Coronary stent fracture, most frequently associated with first-generation drug-eluting stents, is an uncommon yet clinically relevant cause of very late stent failure.

CASE SUMMARY: A 67-year-old man with dyslipidemia, smoking history, hypertension, and prior percutaneous coronary intervention 15 years ago underwent coronary angiography as part of the preoperative evaluation for cholecystectomy. Angiography revealed fracture of a first-generation sirolimus-eluting stent (3.0 × 26 mm) with displacement of struts in the mid left anterior descending artery, with preserved TIMI flow grade III. He presented no symptoms suggestive of angina, and ischemia evaluation with stress echocardiography was negative. A conservative management strategy was adopted.

DISCUSSION: This case highlights the long-term mechanical limitations of early-generation drug-eluting stents and underlines the importance of individualized decision-making guided by symptoms and objective ischemia assessment.

TAKE-HOME MESSAGES: Very late stent fracture may occur decades after implantation, particularly with the use of first-generation drug-eluting stents. Management should be guided by patient symptoms and evidence of ischemia rather than angiographic appearance alone.