Acute stent malfunction in a calcified lesion

Stent fracture is an emerging complication of coronary stenting. Stent fractures were originally reported in the superficial femoral arteries but have since been reported in almost all vascular sites. They are the result of the complex interplay among stent design, the stented segment, plaque morphology, deployment technique, including forceful exaggerated motion in the atrioventricular groove as observed in right coronary artery, long stent, tortuous lesion, stent overexpansion, complex lesion after stenting of a totally occluded vessel, and calcified lesions. Their presentation is highly variable, ranging from asymptomatic, perforation, restenosis, migration of the stent to sudden cardiac death related to stent thrombosis. They have been reported as acute consequences as well as delayed presentation. Stent fractures were initially reported with bare metal stents but are now seen with drug-eluting stents as well. Herein, a case of stent fracture of a third-generation zotarolimus-eluting stent in a 60-year-old woman is reported, with a moderately calcified lesion that was diagnosed by stent boost and successfully treated with restenting using another drug-eluting stent.