A Contemporary Framework for the Diagnosis and Management of Stent Fracture

Stent fracture is a recognized complication following percutaneous coronary intervention, with incidence influenced by stent design, vessel anatomy, and patient-specific factors. Despite advances in stent technology, this condition remains clinically important due to its association with restenosis, thrombosis, and major adverse cardiovascular events. Key mechanistic contributors include stent-related factors such as material properties, design, and deployment technique, as well as vessel-related factors like angulation, calcification, and mechanical stress. Clinical presentation varies from asymptomatic to acute coronary syndromes, often necessitating high-resolution imaging such as stent enhancement or intracoronary imaging for diagnosis. Preventive strategies focus on optimal lesion preparation, potential use of drug-coated balloons and tailored stent selection. Management should be individualized based on fracture severity and clinical context. This article reviews the incidence, pathogenesis, clinical presentation, prevention, diagnosis, and management of stent fracture, and proposes a practical, algorithm to guide diagnosis and intervention, aiming to improve patient outcomes and reduce long-term complications.