Letter to the Editor Multiple stent strut fracture-induced restenosis in a diffuse long lesion treated with overlapping heterogeneous drug-eluting stent Woong Chol Kang, Chan Moon II, Tae Hoon Ahn, Eak Kyun Shin ⁎ Cardiology, Gil Medical Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea Received 16 May 2007; accepted 1 July 2007 Available online 24 September 2007 Abstract Coronary stent fracture can be a potentially serious complication to stenting leading to various complications, such as restenosis, and even occlusion. We reported multiple stent fracture of overlapping paclitaxel and sirolimus-eluting stent. Although an overwhelming majority of stent fracture was reported from sirolimus-eluting stent, our case showed that fracture of paclitaxel-eluting stent could occur by similar mechanisms as in sirolimus-eluting stent. So angiographic follow-up with intravascular ultrasound should be performed to elucidate the clinical significance of stent fracture of DES regardless of DES type. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Stent fracture; Overlapping DES; Restenosis 1. Introduction Despite technical improvements in percutaneous coro- nary interventions (PCI), treatment of diffuse long lesions remains difficult and is associated with an unfavorable outcome. Drug-eluting stents (DES) have greatly reduced the possibility of in-stent restenosis by inhibiting neointimal growth and attenuated the relationship between the stent length and rate of restenosis. But recently stent fracture has emerged as a complication of DES, especially in long coronary lesion with sirolimus-eluting stent (SES). Coronary stent fracture can be a potentially serious complication to stenting leading to various complications, such as restenosis, and even occlusion. We reported multiple stent fracture of overlapping paclitaxel and sirolimus-eluting stent in diffuse long coronary lesion. 2. Case report A 63-year-old female patient visited our hospital due to angina chest pain. She has hypertension and diabetes. But, she denied any history of smoking or hyperlipidemia. In 1998, she has been admitted due to stable angina and implanted bare-metal stent (BMS, Nir stent 2.75 × 16 mm) at distal right coronary artery (RCA). Until she readmitted for evaluation of recurred chest pain ten months ago, there has been no clinical event for 8 years after PCI. On 2nd admission, there was no interval change of ECG findings compared to previous ones and no laboratory abnormality. However, because the chest pain was typical for angina pectoris, we performed coronary angiogram. Coronary angiography showed diffuse 50% stenotic lesion at left anterior descending artery (LAD) with grade II collateral flow to RCA and tubular 80% stenosis at obtuse marginal (OM) artery. And Total occlusion was noted at proximal RCA. Two DESs (paclitaxel-eluting stent, PES 2.75 × 28 mm, International Journal of Cardiology 130 (2008) e30 – e33 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Tel.: +82 32 460 3046/3674; fax: +82 32 460 3117. E-mail address: ekshin@gilhospital.com (E.K. Shin). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.07.032