Stent Fracture and Perforation During Percutaneous Coronary Intervention for In-Stent Restenosis

Background: Stent fracture is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). We present a case of type IV stent fracture during PCI of recurrent in-stent restenosis (ISR) of the right coronary artery. Case Summary: A 64-year-old man with prior coronary artery bypass grafting and recurrent ISR in the right coronary artery underwent PCI involving cutting balloon angioplasty and brachytherapy. Aggressive balloon dilation to achieve optimal results led to a type IV stent fracture with Ellis type III perforation. Prolonged balloon tamponade failed, and a covered stent was successfully deployed to seal the perforation. Discussion: This case highlights the risk of mechanical complications during the management of ISR and the importance of immediate intervention using covered stents in coronary perforations. We discussed case-relevant risk factors and management options for stent fracture and coronary perforation. Take-Home Messages: Operators must remain vigilant for rare complications like stent fractures and perforation in PCI of ISR.