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In situ fracture of stents implanted for relief of pulmonary arterial stenosis in patients with congenitally malformed hearts

Published online by Cambridge University Press:  01 August 2008

Doff B. McElhinney ,
Lisa Bergersen  and
Audrey C. Marshall
Doff B. McElhinney*
Affiliation:
Department of Cardiology, Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Lisa Bergersen
Affiliation:
Department of Cardiology, Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Audrey C. Marshall
Affiliation:
Department of Cardiology, Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
*
Correspondence to: Doff B. McElhinney, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Tel: +1 617 355 9656; Fax: +1 617 739 6282; E-mail: [email protected]
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Abstract

Background

One of the most common uses of stents in patients with congenitally malformed hearts is treatment of pulmonary arterial stenosis. Although there are reports of fractured pulmonary arterial stents, little is known about the risk factors for, and implications of, such fractures.

Methods

We reviewed angiograms to identify fractures in stents previously inserted to relieve stenoses in pulmonary arteries from 1990 through 2001 in patients who also underwent follow-up catheterization at least 3 years after placement of the stent. We undertook matched cohort analysis, matching a ratio of 2 fractured to 1 unfractured stent.

Results

Overall, 166 stents meeting the criterions of our study had been placed in 120 patients. We identified fractures in 35 stents (21%) in 29 patients. All fractured stents were in the central pulmonary arteries, 24 (69%) in the central part of the right pulmonary artery, and all were complete axial fractures, or complex fractures along at least 2 planes. Stent-related factors associated with increased risk of fracture identified by multivariable logistic regression included placement in close apposition to the ascending aorta (p = 0.001), and a larger expanded diameter (p = 0.002). There was obstruction across 28 of 35 fractured stents, which was severe in 11. We re-stented 21 of the fractured stents, and recurrent fracture was later diagnosed in 3 of these. A fragment of the fractured stent embolized distally in 2 patients, without clinically important effects.

Conclusions

In situ fracture of pulmonary arterial stents is relatively common, and in most cases is related to compression by the aorta. There is usually recurrent obstruction across the fractured stent, but fractured stents rarely embolize, and are not associated with other significant complications.

Keywords

Tetralogy of fallotangioplastycatheterization
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 405 - 414
Copyright
Copyright © Cambridge University Press 2008

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References

1.O’Laughlin, MP, Perry, SB, Lock, JE, Mullins, CE. Use of endovascular stents in congenital heart disease. Circulation 1991; 83: 1923–1939.CrossRefGoogle ScholarPubMed
2.O’Laughlin, MP, Slack, MC, Grifka, RG, Perry, SB, Lock, JE, Mullins, CE. Implantation and intermediate-term follow-up of stents in congenital heart disease. Circulation 1993; 88: 605–614.CrossRefGoogle ScholarPubMed
3.Fogelman, R, Nykanen, D, Smallhorn, J, McCrindle, BW, Freedom, RM, Benson, LN. Endovascular stents in the pulmonary circulation: clinical impact on management and medium-term follow-up. Circulation 1995; 92: 881–885.CrossRefGoogle ScholarPubMed
4.Bar-Cohen, Y, Perry, SB, Keane, JF, Lock, JE. Use of stents to maintain atrial defects and fontan fenestrations in congenital heart disease. J Interv Cardiol 2005; 18: 111–118.CrossRefGoogle ScholarPubMed
5.McMahon, CJ, El-Said, HG, Grifka, RG, Fraley, JK, Nihill, MR, Mullins, CE. Redilation of endovascular stents in congenital heart disease: factors implicated in the development of restenosis and neointimal proliferation. J Am Coll Cardiol 2001; 38: 521–526.CrossRefGoogle ScholarPubMed
6.McMahon, CJ, El Said, HG, Vincent, JA, et al. Refinements in the implantation of pulmonary arterial stents: impact on morbidity and mortality of the procedure over the last two decades. Cardiol Young 2002; 12: 445–452.CrossRefGoogle ScholarPubMed
7.Forbes, TJ, Rodriguez-Cruz, E, Amin, Z, et al. The Genesis stent: A new low-profile stent for use in infants, children, and adults with congenital heart disease. Catheter Cardiovasc Interv 2003; 59: 406–414.CrossRefGoogle Scholar
8.Peng, LF, McElhinney, DB, Nugent, AW, et al. Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: a fifteen-year experience. Circulation 2006; 113: 2598–2605.CrossRefGoogle Scholar
9.Nordmeyer, J, Khambadkone, S, Coats, L, et al. Risk stratification, systematic classification, and anticipatory management strategies for stent fracture after percutaneous pulmonary valve implantation. Circulation 2007; 115: 1392–1397.CrossRefGoogle ScholarPubMed
10.Qureshi, AM, McElhinney, DB, Lock, JE, Landzberg, MJ, Lang, P, Marshall, AC. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation. Cardiol Young 2007; 17: 1–12.CrossRefGoogle Scholar
11.Ledesma, M, Jauregui, R, Ceron, CK, et al. Stent fracture after stent therapy for aortic coarctation. J Invasive Cardiol 2003; 15: 719–721.Google ScholarPubMed
12.Carrozza, M, Santoro, G, Giovanna Russo, M, Caianiello, G, Calabro, R. Stress stent fracture: is stent angioplasty really a safe therapeutic option in native aortic coarctation? Int J Cardiol 2006; 113: 127–128.CrossRefGoogle ScholarPubMed
13.Lee, MS, Jurewitz, D, Aragon, J, Forrester, J, Makkar, RR, Kar, S. Stent fracture associated with drug-eluting stents: clinical characteristics and implications. Catheter Cardiovasc Interv 2007; 69: 387–394.CrossRefGoogle ScholarPubMed
14.Koh, TW, Mathur, A. Coronary stent fracture in a saphenous vein graft to right coronary artery – successful treatment by the novel use of the Jomed coronary stent graft: case report and review of the literature. Int J Cardiol 2007; 119: e43–45.CrossRefGoogle Scholar
15.Valibhoy, AR, Mwipatayi, BP, Sieunarine, K. Fracture of a carotid stent: an unexpected complication. J Vasc Surg 2007; 45: 603–606.CrossRefGoogle ScholarPubMed
16.Tsutsumi, M, Kazekawa, K, Onizuka, M, et al. Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology 2007; 49: 253–257.CrossRefGoogle ScholarPubMed
17.Kessler, IM, Mounayer, C, Piotin, M, Spelle, L, Vanzin, JR, Moret, J. The use of balloon-expandable stents in the management of intracranial arterial diseases: a 5-year single-center experience. AJNR Am J Neuroradiol 2005; 26: 2342–2348.Google ScholarPubMed
18.Sahin, S, Memis, A, Parildar, M, Oran, I. Fracture of a renal artery stent due to mobile kidney. Cardiovasc Intervent Radiol 2005; 28: 683–685.CrossRefGoogle ScholarPubMed
19.Sacks, BA, Miller, A, Gottlieb, M. Fracture of an iliac artery Palmaz stent. J Vasc Interv Radiol 1996; 7: 53–55.CrossRefGoogle ScholarPubMed
20.Scheinert, D, Scheinert, S, Sax, J, et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol 2005; 45: 312–315.CrossRefGoogle ScholarPubMed
21.Schlager, O, Dick, P, Sabeti, S, et al. Long-segment SFA stenting – the dark sides: instent restenosis, clinical deterioration, and stent fractures. J Endovasc Ther 2005; 12: 676–684.CrossRefGoogle ScholarPubMed
22.Solis, J, Allaqaband, S, Bajwa, T. A case of popliteal stent fracture with pseudoaneurysm formation. Catheter Cardiovasc Interv 2006; 67: 319–322.CrossRefGoogle ScholarPubMed
23.Meier, GH, Pollak, JS, Rosenblatt, M, Dickey, KW, Gusberg, RJ. Initial experience with venous stents in exertional axillary-subclavian vein thrombosis. J Vasc Surg 1996; 24: 974–981.CrossRefGoogle ScholarPubMed
24.Seriki, DM, Ashleigh, RJ, Butterfield, JS, et al. Midterm follow-up of a single-center experience of endovascular repair of abdominal aortic aneurysms with use of the Talent stent-graft. J Vasc Interv Radiol 2006; 17: 973–977.CrossRefGoogle ScholarPubMed
25.Zaleski, GX, Funaki, B, Rosenblum, J, Theoharis, J, Leef, J. Metallic stents deployed in synthetic arteriovenous hemodialysis grafts. AJR Am J Roentgenol 2001; 176: 1515–1519.CrossRefGoogle ScholarPubMed
26.Yoshida, H, Mamada, Y, Taniai, N, et al. Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma. J Nippon Med Sch 2006; 73: 164–168.CrossRefGoogle ScholarPubMed
27.Forshaw, MJ, Sankararajah, D, Stewart, M, Parker, MC. Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes. Colorectal Dis 2006; 8: 102–111.CrossRefGoogle Scholar
28.Schoefl, R, Winkelbauer, F, Haefner, M, Poetzi, R, Gangl, A, Lammer, J. Two cases of fractured esophageal nitinol stents. Endoscopy 1996; 28: 518–520.CrossRefGoogle ScholarPubMed
29.Zakaluzny, SA, Lane, JD, Mair, EA. Complications of tracheobronchial airway stents. Otolaryngol Head Neck Surg 2003; 128: 478–488.CrossRefGoogle ScholarPubMed
30.van Gameren, M, Witsenburg, M, Takkenberg, JJ, et al. Early complications of stenting in patients with congenital heart disease: a multicentre study. Eur Heart J 2006; 27: 2709–2715.CrossRefGoogle ScholarPubMed
31.Knirsch, W, Haas, NA, Lewin, MA, Uhlemann, F. Longitudinal stent fracture 11 months after implantation in the left pulmonary artery and successful management by a stent-in-stent maneuver. Catheter Cardiovasc Interv 2003; 58: 116–118.CrossRefGoogle ScholarPubMed
32.Flueckiger, F, Sternthal, H, Klein, GE, Aschauer, M, Szolar, D, Kleinhappl, G. Strength, elasticity, and plasticity of expandable metal stents: in vitro studies with three types of stress. J Vasc Interv Radiol 1994; 5: 745–750.CrossRefGoogle ScholarPubMed
33.Duda, SH, Wiskirchen, J, Tepe, G, et al. Physical properties of endovascular stents: an experimental comparison. J Vasc Interv Radiol 2000; 11: 645–654.CrossRefGoogle ScholarPubMed
34.Lossef, SV, Lutz, RJ, Mundorf, J, Barth, KH. Comparison of mechanical deformation properties of metallic stents with use of stressstrain analysis. J Vasc Interv Radiol 1994; 5: 341–349.CrossRefGoogle ScholarPubMed
35.Marrey, RV, Burgermeister, R, Grishaber, RB, Ritchie, RO. Fatigue and life prediction for cobalt-chromium stents: a fracture mechanics analysis. Biomaterials 2006; 27: 1988–2000.CrossRefGoogle ScholarPubMed
36.Smith, WF. Mechanical properties of metals. In: Principles of Materials Science and Engineering. McGraw-Hill Higher Education, New York, 1986, pp. 286–287.Google Scholar
37.Hausdorf, G. Mechanical and biophysical aspects of stents. In: Rao, PS, Kern, MJ (eds). Catheter Based Devices for The Treatment of Non-Coronary Cardiovascular Disease In Adults and Children. Lippincott Williams & Wilkins, Philadelphia, 2003, pp. 271–284.Google Scholar