Korean Circ J.  2009 May;39(5):205-208. 10.4070/kcj.2009.39.5.205.

Very Late Thrombosis of a Drug-Eluting Stent After Discontinuation of Dual Antiplatelet Therapy in a Patient Treated With Both Drug-Eluting and Bare-Metal Stents

• Kim SS
• Jeong MH
• Sim DS
• Hong YJ
• Kim JH
• Ahn YK
• Kang JC

• KMID: 1826020
• DOI: http://doi.org/10.4070/kcj.2009.39.5.205

Abstract

Drug-eluting stents (DESs) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. However, late stent thrombosis seems to occur more frequently with DESs and is closely associated with the discontinuation of dual antiplatelet therapy. We report a case of very late stent thrombosis after discontinuation of dual antiplatelet therapy. The patient suffered from acute myocardial infarction (MI) and underwent bare metal stent (BMS) implantation in the left anterior descending artery (LAD) five years prior to presentation. Three years after BMS implantation, he presented again with acute MI and had a DES implanted in the right coronary artery (RCA). He ran out of his medication, but failed to refill his prescription. Sixteen days after discontinuing medication, he experienced an episode of chest pain and was taken to the cardiac catheterization laboratory, where he was found to have thrombosis in the DES, but no thrombosis in the BMS. It is possible that DESs are more vulnerable to late thrombosis than are BMSs, supporting the use of prolonged dual antiplatelet therapy in patients treated with DESs. The patient was successfully treated with balloon angioplasty and thrombus aspiration without complications.

Keyword

Thrombosis; Stents; Platelets

MeSH Terms

Angioplasty, Balloon
Arteries
Blood Platelets
Cardiac Catheterization
Cardiac Catheters
Chest Pain
Coronary Artery Disease
Coronary Vessels
Drug-Eluting Stents
Humans
Myocardial Infarction
Prescriptions
Stents
Thrombosis

Figure

• 

  Fig. 1 Diagnostic coronary angiogram and primary percutaneous intervention. A: CAG revealed total occlusion of the proximal left anterior descending artery (LAD) (arrow). B: a bare metal stent (3.5×28 mm Arthos Inert Stent) was successfully placed in the occluded LAD. CAG: coronary angiogram.

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  Fig. 2 The first follow-up coronary angiogram and percutaneous coronary intervention for restenosis. A: CAG revealed type III diffuse in-stent restenosis in the proximal left anterior descending artery (LAD) (arrow). B: plain balloon angioplasty was successfully performed for the treatment of in-stent restenosis in the LAD. CAG: coronary angiogram.

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  Fig. 3 The second follow-up coronary angiogram and percutaneous coronary intervention for de novo lesion in right coronary artery. A: CAG revealed a patent LAD stent (arrow). B: near total occlusion of the proximal RCA was also detected (arrow). C: a TAXUS stent (2.75×32 mm) was successfully implanted after dilation using a 2.5×20 mm balloon in the proximal RCA. CAG: coronary angiogram, LAD: left anterior descending artery, RCA: right coronary artery.

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  Fig. 4 Follow-up electrocardiographic finding. The ECG showed newly developed ST-segment depression and T-wave inversion in leads II, III, and aVF. ECG: electrocardio-gram.

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  Fig. 5 The third follow-up coronary angiogram. A: total occlusion of the proximal right coronary artery at the level of the stent with evidence of thrombosis. B: grade II collateral flow from the left coronary artery (arrow). C: left coronary angiogram revealed a patent bare metal stent in the left anterior descending artery (arrow).

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  Fig. 6 Percutaneous coronary intervention for the very late stent thrombosis in right coronary artery. A: a balloon angioplasty was performed to treat total occlusion of the stented right coronary artery. B: final coronary angiogram showed good distal flow without residual stenosis.

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