High frequency of brachiocephalic trunk stent fractures does not impair clinical outcome

Stenting is the preferred, minimally invasive treatment for innominate artery (IA) stenosis or occlusion. Stent fractures in the IA have not been assessed in larger cohorts. In this retrospective study, we examined the frequency and risk factors of IA stent fractures.

The final analysis included 32 patients (15 women; mean age, 59.4 ± 12.0 years) with 32 balloon-expandable stents (2000 to 2009). In 2010, the patients were asked to come back for a fluoroscopic examination of the implanted stents. Stent fractures and their relationship to atherosclerotic risk factors, lesion characteristics, postprocedural symptoms, and in-stent restenosis were analyzed. Fisher exact test and univariate Cox regression analysis were used in the statistical evaluation.

Lesions were >20 mm in 14 patients (44%) or heavily calcified in 13 (41%). The mean follow-up time was 33.4 ± 21.0 months. Postprocedural symptoms were noted in nine patients (28%). Significant restenosis was detected in 22% of the implanted stents, and 11 stent fractures (34%) were found. The prevalence of heavily calcified lesions, postprocedural symptoms, and in-stent restenosis did not differ significantly between groups with and without fracture. Long lesions were associated with an increased incidence of stent fracture (hazard ratio, 5.09; 95% confidence interval, 1.33-19.48; P = .017). No correlation was observed between stent fractures and old age (≥70 years), female gender, smoking, hypertension, hyperlipidemia, or diabetes mellitus.

IA stent fractures are common but seem to have no effect on symptoms and in-stent restenosis rates.