• Xavier Freixa, Ali S Almasood, Sohail Q Khan, Rodrigo Wainstein, Azriel Osherov, Karen Mackie, Peter H Seidelin, and Vladimír Džavík.
• Peter Munk Cardiac Centre, Interventional Cardiology Program, Division of Cardiology, University Health Network, Toronto, Ontario, Canada.
• Catheter Cardiovasc Interv. 2012 Mar 1; 79 (4): 559-65.

ObjectiveTo compare the outcomes between paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) for the treatment of drug-eluting stent (DES) fracture.BackgroundDES fracture is considered as an important predictor of in-stent restenosis (ISR). However, little data are available evaluating the optimal treatment for this complication of coronary stenting.MethodsFrom January 1, 2004 to December 31, 2008, patients with DES ISR treated with a second DES were identified and evaluated for stent fracture. Stent fracture was defined by the presence of strut separation in multiple angiographic projections, assessed by two independent reviewers. Target lesion revascularization (TLR) at 6 and 12 months were the primary end points.ResultsOf 131 lesions with DES ISR treated with a second DES, we found 24 patients (24 lesions, 18.2%) with angiographically confirmed stent fracture. Of these, 20 patients (20 lesions) treated with either PES (n = 11/55%) or SES (n = 9/45%) were included in the study. TLR at 6 months occurred in 9% of patients treated with PES and 22% of those treated with SES (P = 0.41). After 12 months, TLR was 9% and 55.5%, respectively (P = 0.024).ConclusionsThis study demonstrates a high incidence of stent fracture in patients presenting with DES ISR in need of further treatment with another DES. The suggested association between treatment of stent fracture-associated DES ISR with PES as compared with SES, and better long-term outcomes, is in need of confirmation by larger prospective registries and randomized trials.Copyright © 2011 Wiley Periodicals, Inc.

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