case_images: PMC6009011_01
case_images: 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).
case_images: CRIC2018-4579184.001.jpg
case_images: PMC6009011_01_CRIC2018-4579184.001.jpg
case_images: fig1
case_images: The stenosis extended from the mid-LAD to a bit passed the LIMA anastomosis, with retrograde flow into the LIMA (Figure 1).
case_images: 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.
case_images: CRIC2018-4579184.002.jpg
case_images: PMC6009011_01_CRIC2018-4579184.002.jpg
case_images: fig2
case_images: 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.
case_images: 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.
case_images: CRIC2018-4579184.003.jpg
case_images: PMC6009011_01_CRIC2018-4579184.003.jpg
case_images: fig3
case_images: 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.
case_images: Repeat coronary angiogram showing mid-LAD stent fracture with 70% in-stent restenosis at the site of anastomosis between LAD and LIMA (asterisk).
case_images: CRIC2018-4579184.004.jpg
case_images: PMC6009011_01_CRIC2018-4579184.004.jpg
case_images: fig4
case_images: It revealed a mid-LAD stent fracture with 70% in-stent restenosis (fractional flow reserve of 0.78) (Figure 4).
case_images: 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.
case_images: CRIC2018-4579184.005.jpg
case_images: PMC6009011_01_CRIC2018-4579184.005.jpg
case_images: fig5
case_images: TIMI III flow and no residual stenosis (Figure 5). The patient tolerated the procedure and was discharged in stable condition.