Multiple PCI Failures Due to Excessive Coronary Hinge Motion

BACKGROUND: Excessive vessel movement due to hinge motion (HM) may be one of the major contributors to in-stent thrombosis and subsequent stent fractures. CASE SUMMARY: A 53-year-old man was admitted due to an acute myocardial infarction. Emergency angiography revealed thrombotic right coronary artery occlusion associated with excessive HM. After stenting, he was readmitted for in-stent thrombosis, and in-stent total occlusion and stent fractures were observed at 1-year follow-up; the stent fracture site is precisely located at the HM. Considering the persistent severe HM, coronary artery bypass grafting was recommended. DISCUSSION: Chronic mechanical stress due to HM of the vessel may play an important role in stent fracture. Stent implantation should be avoided in coronary regions with curves due to severe HM. Shorter stent, drug-coated balloons, or coronary artery bypass grafting should be prioritized. TAKE-HOME MESSAGES: Stent implantation should be avoided in regions with severe HM. Shorter stents, drug-coated balloons, or coronary artery bypass grafting should be considered.