A Broken Railway: A Subclavian Arterial Stent Fracture

Abstract

A 63 year-old male moving company worker, presented with left arm pain when lifting some luggage for 3 months. His blood pressure revealed 84/53 and 134/72 mmHg in left and right arm each. Computed tomographic angiography (CTA) showed a total occlusion of the left proximal subclavian artery (Figure 1A). Percutaneous transluminal angioplasty (PTA) with a balloon expandable Express LD® stent (7×57 mm; Boston Scientific, Marlborough, MA, USA) was performed successfully, however 11 days postoperatively his symptom reoccurred and stent fracture was suspected in routine chest X-ray, confirmed by CTA and causing a significant stenosis (Figure 1B-E). This lesion was re-stented with self-expandable Absolute Pro® stent (7×40 mm; Abbott Laboratories, Abbott Park, IL, USA) (Supplementary Videos 1, 2, 3, 4). Six months post-rePTA treatment, there were no symptom and no definite stent fracture on chest X-ray (Figure 1F and G). The systolic blood pressure showed 120–130 mmHg in both arms.