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Images and Case Reports in Interventional Cardiology

Major Polymer Damage of Drug-Eluting Stents

Marcus Wiemer, MD; Thomas Butz, MD; Khalid Mahmood, MD and Dieter Horstkotte, MD, PhD, FESC, FACCP

From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.

Correspondence to Marcus Wiemer, MD, Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr.11, 32545 Bad Oeynhausen, Germany. E-mail mwiemer{at}hdz-nrw.de

A 67-year-old man presented with stable angina pectoris on exertion. He had a history of type 2 diabetes, severe peripheral vascular disease with bilateral above-knee amputations, renal insufficiency requiring dialysis, and arterial hypertension for more than 20 years.

Coronary angiography revealed a long, calcified 90% bifurcation lesion of the left anterior descending after the ostium of the second diagonal branch. Despite predilatation and marked effort, 2 drug-eluting stents, a 3.0x24 and a 3.0x12 mm Endeavor RX (Medtronic Vascular) failed to cross the lesion.

We assumed that major mechanical forces in the calcified vessel acting on both Endeavor RXstents cause polymer damage. Therefore, the entire accessible surface areas of both stents were examined in the expanded state using an environmental scanning electron microscope (XL30 ESEM, Philips). The area of coating defects was nearly 20% in both stents related to the estimated total stent surface calculated by a quantitative analysis (arrows indicating scratched polymer presenting bare metal surface; Figure).

View larger version (59K): [in this window] [in a new window] [Download PPT slide]   Figure. A, Endeavor RX 3.0 x 24; B, Endeavor RX 3.0 x 12, expanded with arrows indicating scratched polymer presenting bare metal surface.

 
Few days later using a different technique, the lesion was covered with a 3.0x18 mm Cypher Select (Cordis, Johnson&Johnson) stent with a good final result.

Placement of drug-eluting stents in calcified vessels with challenging deliverability might cause severe polymer damage. It has to be assumed that this effect is even worse in smaller vessels. Polymer damage up to 20% of the surface might also have an impact on higher late lumen loss.

	Acknowledgments

 
Disclosures

None.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wiemer, M. Articles by Horstkotte, D. Search for Related Content PubMed Articles by Wiemer, M. Articles by Horstkotte, D. Related Collections Catheter-based coronary interventions: stents