Fatal Ostial Right Coronary Artery Coronary Stent Fracture and Perforation Induced by Mechanical Stress Between the Sternum and Dilated Aortic Root

A 79-year-old woman with a history of open abdominal aortic aneurysm repair presented with worsening angina. Her ECG showed mild ST-segment depression at rest (Figure 1A). Computed tomography coronary angiography revealed a critical stenosis at the right coronary artery ostium without atherosclerotic plaque, which appeared to be induced by extrinsic mechanical compression between the sternum and dilated aortic root (Figure 2 and Movie I in the online-only Data Supplement). Because she refused to undergo cardiac surgery, elective percutaneous coronary intervention for the ostial right coronary artery lesion was performed (Movie II in the online-only Data Supplement). Intravascular ultrasound findings were similar to those observed on computed tomography coronary angiography (Figure 3 and Movie III in the online-only Data Supplement). A Liberte bare metal stent 4.0/12 mm was directly deployed, followed …