J Lipid Atheroscler.  2012 Dec;1(2):95-100. 10.12997/jla.2012.1.2.95.

Recurrent Stent Thrombosis and Pulmonary Thromboembolism Associated with Hyperhomocysteinemia

• Kim MC
• Jeong MH
• Jang SY
• Choi HS
• Cho KH
• Hwang SH
• Lee MG
• Park KH
• Sim DS
• Hong YJ
• Kim JH
• Ahn Y
• Kang JC

• KMID: 2198367
• DOI: http://doi.org/10.12997/jla.2012.1.2.95

Abstract

Stent thrombosis is a fatal complication that can cause sudden cardiac death in patients implanted coronary stent. Also, pulmonary thromboembolism is associated with increased mortality. Usually, these vascular thromboembolic diseases did not occured simultaneously. If this circumstance develops, possible mechanisms and causes should be described. Here, we report a case of patient underwent percutaneous coronary intervention under diagnosis of ST-segment elevation myocardial infarction with recurrent stent thrombosis and pulmonary thromboembolism associated with hyperhomocysteinemia despite optimal medical therapy.

Keyword

Hyperhomocysteinemia; Coronary thrombosis; Pulmonary embolism

MeSH Terms

Coronary Thrombosis
Death, Sudden, Cardiac
Humans
Hyperhomocysteinemia
Myocardial Infarction
Percutaneous Coronary Intervention
Pulmonary Embolism
Stents
Thrombosis

Figure

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  Fig. 1 Primary PCI; CAG showed TTO in proximal RCA (A: white arrow) and successful PCI with coronary stenting (B: Coroflex-Blue 4.0×19 mm, B. Braun Systems).

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  Fig. 2 Filling defects in segmental pulmonary arteries in left lower lobe (A and B: white arrow).

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  Fig. 3 Stent thrombosis and de novo lesion in distal to stent (A and B: arrow heads). Successful PCI with direct stenting using bare-metal stent (C and D: arrow heads, Coroflex-Blue 3.5×19 mm, B. Braun Systems).

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  Fig. 4 Critical spasm over RCA and acute stent thrombosis (A: white arrow). Improved coronary flow after nitrate and abciximab infusion (B).

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  Fig. 5 Follow up coronary angiogram after 6 months until first admission day (A: Right coronary artery, B: Left coronary artery). There were no in-stent restenosis, stent thrombosis, and de novo lesion.

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  Fig. 6 Stent thrombosis in proximal RCA stent (A). Successful primary PCI with intracoronary glycoprotein IIb/IIIa inhibitor. There are small amount of remnant thrombi in culprit lesion (B).

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  Fig. 7 Duration of anti-platelet and oral anti-coagulation medication. His stent thrombosis events; acute, subacute, and very late stent thrombosis are presented in non painted box during clinical follow up period.

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