Very late stent thrombosis after sirolimus-eluting stent implantation: evaluation by intravascular ultrasound and optica
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CASE REPORT
Very late stent thrombosis after sirolimus-eluting stent implantation: evaluation by intravascular ultrasound and optical coherence tomography Tomohito Mabuchi • Susumu Fujino • Masato Yamaguchi • Yoshihiro Noji • Taro Ichise • Takahiko Aoyama
Received: 15 November 2012 / Accepted: 26 March 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract A 58-year-old man was admitted to our hospital with acute anterior myocardial infarction that occurred 4 years after single sirolimus-eluting stent (SES) implantation in the left anterior descending artery. He had been undergoing continuous dual antiplatelet therapy. Emergency coronary angiography showed total thrombotic occlusion and peri-stent contrast staining at the SES site. The lesion was evaluated using intravascular ultrasound (IVUS) and optical coherence tomography (OCT) after thrombectomy. Vessel remodeling was detected on IVUS, and multiple interstrut hollows and thrombi were observed on OCT. These findings were associated with very late stent thrombosis after SES implantation. Keywords Very late stent thrombosis Sirolimus-eluting stent Peri-stent contrast staining
Introduction Drug-eluting stents have been proved to decrease restenosis rates and the need for repeated revascularization [1]. However, some problems such as stent thrombosis have been reported to be associated with the use of drug-eluting stents [2]. Very late stent thrombosis (VLST) after firstgeneration drug-eluting stent implantation is rare and is associated with serious complications such as acute myocardial infarction and sudden cardiac death [3]. Many imaging modalities have been used to investigate VLST
T. Mabuchi (&) S. Fujino M. Yamaguchi Y. Noji T. Ichise T. Aoyama Department of Cardiology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui, Fukui 910-0846, Japan e-mail: [email protected]
after first-generation drug-eluting stent implantation. Here, we report the case of a 58-year-old man who developed VLST as evaluated by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) 4 years after sirolimus-eluting stent (SES) implantation.
Case report A 58-year-old man was hospitalized with angina pectoris and treated with a single SES (CYPHERÒ, Johnson & Johnson, New Brunswick, NJ, USA) for severe stenosis of a proximal lesion in the left anterior descending artery (LAD) 4 years ago (Fig. 1a, b). One year after SES implantation, routine follow-up coronary angiography revealed no in-stent restenosis or peri-stent contrast staining (PSS) at the SES site (Fig. 1c). Four years after SES implantation, sudden chest discomfort necessitated hospital admission. Ventricular fibrillation and direct cardioversion were performed en route to the hospital in the ambulance. Acute myocardial infarction was diagnosed by electrocardiography and blood chemistry analysis. Coronary risk factors included hypertension, smoking, and family history of heart disease. He had been undergoing dual antiplatelet therapy with aspirin and clopid
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