Compared with bare-metal stents, drug-eluting stents (DES) have greatly reduced the risk of in-stent restenosis (ISR) by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF) has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES) may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs) represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR. 1. Introduction The occurrence of stent fractures (SF) is recognized as a potential complication of stent deployment. Its incidence varies markedly in published reports, ranging from less than 1% to more than 16% [1–3]. Little is known about the precise incidence of SF in the “real world”. However, SF is likely to be underrecognized due to difficulty in diagnosis and the lack of standardized definitions. Stent fracture has currently become an important concern after drug-eluting stent (DES) implantation due to its potential association with in-stent restenosis (ISR) and stent thrombosis [4]. Sirolimus-eluting stents (SES), as compared with paclitaxel (PES) or zotarolimus-eluting stents (ZES), are considered the DES with the highest risk of SF [5, 6]. The everolimus eluting stent (EES; Multilink Vision platform, Abbott Vascular, Temecula, CA), is a new DES with promising long-term results [7–9]. As compared with other DES, EES provides the thinnest available strut profile (0.08？mm) [10]. The incidence of SF with EES has never been assessed. The present paper describes two cases of EES fracture associated with ISR. 2. Case Reports 2.1. Case-1 This patient was a 72-year-old lady with a chief complaint of prolonged chest pain. Her medical history included hypertension, hyperlipidemia, family history of coronary artery disease, and cutaneous lupus erythematosus. In May 2009, she experienced exertional chest pain and underwent coronary angiography which revealed a calcific 90% mid- and 80% distal RCA stenosis. The distal lesion was treated with rotational atherectomy using 1.25？mm burr following which a 2.25 × 23？mm Xience V stent (Abbott Vascular Devices, Santa Clara, CA) was deployed at 16 atmospheres (ATM). A 2.75 × 28？mm Xience V stent was then deployed at 16？ATM in the mid-segment, and postdilated
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