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Structural failure of a coronary stent
  1. h.schuehlen{at}

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A 71 year old man was admitted for treatment of a symptomatic severe stenosis of the right coronary artery. After balloon angioplasty, two 16 mm long stents were placed with a 2.5 mm balloon (inflation pressure 20 atm) to cover a dissection at the dilated vessel segment. The implanted stents were multicellular steel stents with an iridium oxide coating to enhance visibility and biocompatibility (Lunar IrOx-Stent, InFlow Dynamics, Munich, Germany). The final angiographic result is illustrated (below left, image A). The adjacent image B shows the stented segment without contrast injection where the stents are highly visible. It illustrates that they are all well expanded, and there is minimal overlap of the two stents.

Four months after the procedure, the patient developed recurrent symptoms and was referred to us again. In the follow up angiogram there was a subtotal occlusion in the mid section of the stented segment (below right, image A). The adjacent image B shows the stented segment without contrast injection. It reveals a compressed segment of the distal stent. Compared to the initial result, the outer diameter in this segment of the stent was compressed from 2.7 mm to 1.8 mm. The outer diameters of other segments were unchanged. Repeat angioplasty was not successful as the compressed stent segment could not be passed with a guide wire.