PMC6009011_01
Coronary angiogram showing a long mid-LAD stenosis of 95%, extending from the mid-LAD (dotted blue line) to an area just below the anastomosis with LIMA (white asterisk), with retrograde filling into LIMA (red line).
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fig1
The stenosis extended from the mid-LAD to a bit passed the LIMA anastomosis, with retrograde flow into the LIMA (Figure 1).
Coronary angiogram showing TIMI III flow over mid-LAD (dotted blue line) and the point of anastomosis (asterisk) after the deployment of Synergy PtCr EES. Note that there is a mild deformity of the stent, which conforms to the coronary anatomy and anastomotic site.
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fig2
A slight kink in the distal one-third of the stent at the LIMA insertion point was noted (Figure 2).  Figure 3 further demonstrates the movement of the intact stent during diastole and systole.
Coronary angiogram showing conformational changes of intact stent during the cardiac cycle (diastole on the left, systole on the right). It can be inferred that various forces are creating a hinge-type motion on the intact stent.
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fig3
A slight kink in the distal one-third of the stent at the LIMA insertion point was noted (Figure 2).  Figure 3 further demonstrates the movement of the intact stent during diastole and systole.
Repeat coronary angiogram showing mid-LAD stent fracture with 70% in-stent restenosis at the site of anastomosis between LAD and LIMA (asterisk).
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fig4
It revealed a mid-LAD stent fracture with 70% in-stent restenosis (fractional flow reserve of 0.78) (Figure 4).
Repeat coronary angiogram showing TIMI III flow in mid-LAD at the point of anastomosis with LIMA (asterisk) after Xience Alpine DES was deployed inside the fractured Synergy DES.
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fig5
TIMI III flow and no residual stenosis (Figure 5). The patient tolerated the procedure and was discharged in stable condition.