Korean Circ J.  2007 Feb;37(2):87-90. 10.4070/kcj.2007.37.2.87.

Intracoronary Stent Deployment without Antiplatelet Agents in a Patient with Idiopathic Thrombocytopenic Purpura

• Park HJ
• Seung KB
• Kim PJ
• Kang HH
• Park CS
• Kil UH
• Choi MS
• Baek SH
• Kim JH
• Choi KB

• KMID: 1859087
• DOI: http://doi.org/10.4070/kcj.2007.37.2.87

Abstract

Deciding on the appropriate antiplatelet therapy is a challenge when treating patients with idiopathic thrombocytopenic purpura (ITP) and who are undergoing percutaneous coronary intervention (PCI). We describe here a case of PCI in a patient with chronic, refractory ITP. A 61-year-old woman presented with exertional chest pain and a low platelet count (4 x 109/L) at admission. Coronary angiography revealed 99% stenosis of the mid left anterior descending artery and 95% stenosis of the mid left circumflex artery. Antiplatelet agents couldn't be administered because of the risk of bleeding. After transfusion of platelets and administering intravenous immunoglobulin, we deployed baremetal stents in both lesions without administering any antiplatelet agents. Although focal in-stent restenosis developed 5 months later, there was no episode of stent thrombosis despite not using antiplatelet agents. The present case suggests that the rate of stent thrombosis may be lower was previously thought and antiplatelet therapy may be considered on a case by case for patient suffering with thrombocytopenia.

Keyword

Myocardial infarction; Microvascular integrity

MeSH Terms

Arteries
Chest Pain
Constriction, Pathologic
Coronary Angiography
Female
Hemorrhage
Humans
Immunoglobulins
Middle Aged
Myocardial Infarction
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors*
Platelet Count
Purpura, Thrombocytopenic, Idiopathic*
Stents*
Thrombocytopenia
Thrombosis
Immunoglobulins
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 A case of intracoronary stent playment in a patients with idiopathic thrombocytopenia purpura. A: coronary angiogram in the right anterior oblique view showed 99% stenosis in the middle segment of the left anterior descending artery (arrow) and 95% stenosis in the middle segment of the left circumflex artery (arrow head). B: percutaneous coronary intervention was performed successfully with baremetal stents in both stenotic lesions. C: 5 months later, focal in-stent restenosis developed in both lesions in which the baremetal stents were deployed. D: balloon angioplasty was performed in both in-stent restenotic lesions and mild residual stenotic lesions were left.

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