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Prevalence and clinical impact of stent fractures after femoropopliteal stenting

Clinical and Interventional Angiology, Heart Center-University of Leipzig, Leipzig, Germany

Manuscript received April 1, 2004; revised manuscript received October 17, 2004, accepted November 15, 2004.

^* Reprint requests and correspondence: Dr. Dierk Scheinert, Clinical and Interventional Angiology, Department of Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany (Email: dierk.scheinert{at}gmx.de).

OBJECTIVES: The aim of this study was to investigate the occurrence and the clinical impact of stent fractures after femoropopliteal stenting.

BACKGROUND: The development of femoral stent fractures has recently been described; however, there are no data about the frequency and the clinical relevance.

METHODS: A systematic X-ray screening for stent fractures was performed in 93 patients. In total, 121 legs treated by implantation of self-expanding nitinol stents were investigated after a mean follow-up time of 10.7 months. The mean length of the stented segment was 15.7 cm.

RESULTS: Overall, stent fractures were detected in 45 of 121 treated legs (37.2%). In a stent-based analysis, 64 of 261 stents (24.5%) showed fractures, which were classified as minor (single strut fracture) in 31 cases (48.4%), moderate (fracture of >1 strut) in 17 cases (26.6%), and severe (complete separation of stent segments) in 16 cases (25.0%). Fracture rates were 13.2% for stented length 8 cm, 42.4% for stented length >8 to 16 cm, and 52.0% for stented length >16 cm. In 21 cases (32.8%) there was a restenosis of >50% diameter reduction at the site of stent fracture. In 22 cases (34.4%) with stent fracture there was a total stent reocclusion. According to Kaplan-Meier estimates, the primary patency rate at 12 months was significantly lower for patients with stent fractures (41.1% vs. 84.3%, p < 0.0001).

CONCLUSIONS: There is a considerable risk of stent fractures after long segment femoral artery stenting, which is associated with a higher in-stent restenosis and reocclusion rate.

Abbreviations and Acronyms   SFA = superficial femoral artery

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