Prospective identification of stent fracture by enhanced stent visualization system during percutaneous coronary intervention

Background: No study has evaluated the clinical consequences of stent fracture (SF) detected during the index percutaneous coronary intervention (PCI). Thus, we sought to investigate the relationship between SF detected during PCI and clinical outcome. Methods and Results: We consecutively enrolled 832 patients with SF-predisposing factors undergoing 2nd-generation drugeluting stent implantation and enhanced stent visualization (ESV) system evaluation to detect SF at index PCI. The primary endpoint was a 9-month device-oriented endpoint (DOCE, including cardiac death, target vessel myocardial infarction, and target lesion revascularization). We observed 136 SF in 115 patients (14% of study population). SF I–II was present in 78 patients (68% of patients with SF), and SF III–IV occurred in 37 patients (32%). DOCE at 9 months occurred in 135 patients (16% of the overall population). There was a significant difference in DOCE occurrence between the 3 groups (P=0.006 at log-rank), driven by the SF III–IV group (P=0.001 vs. no SF group, and P=0.01 vs. SF I–II group). In 23 cases of SF III–IV (62%) a further stent was implanted. DOCE occurrence was significantly higher in patients with “untreated” type III–IV SF as compared with the “treated” ones (9% vs. 79%, P<0.01). Conclusions: The ESV system is helpful in detecting SF during the index PCI. Type III–IV SFs are associated with a higher incidence of DOCE.