Very late stent thrombosis occurring simultaneously in sirolimus-eluting stents and bare-metal stent in three different
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CASE REPORT
Very late stent thrombosis occurring simultaneously in sirolimus-eluting stents and bare-metal stent in three different coronary vessels Yoshitaka Kawaguchi • Junpei Katayama • Azumi Kumazawa • Hirofumi Sugiyama • Tomoyuki Watanabe • Nobuyuki Wakahara
Received: 12 February 2009 / Accepted: 20 May 2010 / Published online: 24 July 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract A 36-year-old male was diagnosed with acute inferior myocardial infarction (MI). Emergent coronary angiography (CAG) revealed an occlusive lesion in the distal segment of the right coronary artery (RCA). The proximal and distal sites of the lesion were treated with a bare-metal stent (BMS) and a sirolimus-eluting stent (SES), respectively. Nine days later, he underwent elective percutaneous coronary intervention (PCI). Two SESs were implanted for the stenotic lesion in the left anterior descending artery (LAD), in addition to one SES for the mid-stenotic lesion in the left circumflex artery (LCX). Nine months after PCI, follow-up CAG revealed no restenosis at any stent-implanted site. Two years and 4 months after PCI, he was admitted to our hospital because of acute anterior MI. Emergent CAG revealed total thrombotic occlusion in the in-stent proximal site of LAD. Moreover, thrombotic lesions were also observed in in-stent sites: in both BMS of RCA and SES of LCX. He underwent intracoronary aspiration thrombectomy and plain old balloon angioplasty for LAD using intra-aortic balloon pumping. PCI for the thrombotic lesions in RCA and LCX was not performed. Seventeen days after the stent thrombosis, CAG revealed the complete disappearance of thrombi in LAD, LCX, and RCA. Keywords Stent thrombosis Incomplete stent apposition Coronary artery
Y. Kawaguchi (&) J. Katayama A. Kumazawa H. Sugiyama T. Watanabe N. Wakahara Department of Cardiology, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Sizuoka 418-0076, Japan e-mail: [email protected]
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Introduction Late stent thrombosis (LST) is a problem in the drugeluting stent (DES) era. We report on a patient with very late stent thrombosis (VLST) occurring simultaneously in the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA).
Case report Acute myocardial infarction (MI) A 36-year-old male was admitted to our hospital with a sudden onset of chest pain. Electrocardiogram (ECG) showed ST-segment elevation in the inferior leads. Emergent coronary angiography (CAG) revealed total occlusion in the distal RCA (Fig. 1A), as well as 90% stenosis in the proximal LAD and chronic total occlusion in the mid LCX (Fig. 1B). Therefore, he underwent percutaneous coronary intervention (PCI) for the RCA lesion. After aspiration thrombectomy, the lesion was predilated with a 2.5-mm balloon: a 3.5 9 23 mm sirolimus-eluting stent (SES) (CypherÒ, Cordis, Johnson & Johnson, Warren, NJ, USA) and a 4.0 9 30 mm bare-metal stent (BMS) (DriverÒ, Medtronic, Santa Rosa, CA, USA) were over
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