Does anticoagulation therapy prevent thrombosis in coronary stent grafts?
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CASE REPORT
Does anticoagulation therapy prevent thrombosis in coronary stent grafts? Yuki Honda1 • Kohei Wakabayashi2 • Takayasu Suzuki3 • Hiroshi Suzuki4
Received: 9 March 2016 / Accepted: 15 November 2016 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract A polytetrafluoroethylene (PTFE)-covered stent was deployed for enlarging coronary aneurysms in a 73-year-old man. Optical coherence tomography (OCT) and coronary angioscopy performed 3 months later revealed naked stent struts and thin patches of red thrombi covering the PTFE membrane even under dual antiplatelet therapy (DAPT). After 5-month warfarin administration under DAPT, OCT and angioscopy showed a clear extinction of the thin patches of red thrombi on the PTFE membrane and stent struts, although most of the struts were still naked. The addition of anticoagulation therapy to DAPT may reduce thrombosis events in patients treated with PTFE-covered stents. Keywords Polytetrafluoroethylene (PTFE)-covered stent Stent thrombosis Anticoagulation therapy Angioscopy
Introduction A polytetrafluoroethylene (PTFE)-covered stent is a PTFE sheet sandwiched within two metallic stents. The device is used for the treatment of special conditions, such as coronary artery perforation or aneurysm. Its efficacy is compromised, however, by high rates of acute myocardial infarction and restenosis even in patients receiving dual antiplatelet therapy (DAPT) [1]. A recent study also showed very high incidence of cardiovascular events in patients treated with PTFE-covered stent [2]. Extreme delays of endothelialization in the PTFE membrane have been suggested to play a role in stent failure [3]. It suggests that DAPT reduces thrombosis events in bare-metal and drug-eluting stents [4], but not enough in PTFE-covered stents. Patients treated with PTFE-covered stents, therefore, require an additional therapy. Anticoagulation therapy is one possible strategy for preventing thrombosis in these patients.
Case presentation Electronic supplementary material The online version of this article (doi:10.1007/s12928-016-0443-8) contains supplementary material, which is available to authorized users. & Kohei Wakabayashi [email protected] 1
Division of Cardiology, Fuji Hospital, Shizuoka, Japan
2
Division of Cardiology, Department of Internal Medicine, Showa University Koto-Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo 135-8577, Japan
3
Division of Cardiovascular Surgery, Fuji Hospital, Shizuoka, Japan
4
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
A 73-year-old man was treated with two PTFE-covered stents (JOSTENTÒ 2.8/16 and 3.5/16 mm for the middle and distal segments of the right coronary artery, respectively) to seal two enlarging aneurysms that had formed after the implantation of a second-generation everolimuseluting stent (Fig. 1). DAPT, aspirin, and clopidogrel were adequately maintained after the stents were implanted. Follow-up angiography was performed at 3 months. Optica
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