Korean Circ J.  2013 May;43(5):343-346. 10.4070/kcj.2013.43.5.343.

Successful Prasugrel Rescue Therapy in Clopidogrel Resistant Patients Who Had Recurrent Stent Thrombosis of Drug-Eluting-Stent: The Role of Prasugrel in Clopidogrel Nonresponders

• Lee SH
• Kim BK
• Oh J
• Park JS
• Lee DJ
• Lee HC
• Kim JH
• Hong MK

• KMID: 2224933
• DOI: http://doi.org/10.4070/kcj.2013.43.5.343

Abstract

Stent thrombosis is a very serious problem after drug-eluting stent (DES) implantation even though its incidence is about or less than 1%. As the clopidogrel resistance is expected to play an important role in the occurrence of stent thrombosis, new anti-platelet agents overcoming this issue can give us another choice. We experienced a case of a 58-year-old male with successful prasugrel rescue therapy in a patient with clopidogrel resistance who had recurrent stent thrombosis following DES implantation.

Keyword

Drug-eluting stents; Thrombosis; Clopidogrel; Prasugrel

MeSH Terms

Drug-Eluting Stents
Humans
Incidence
Male
Piperazines
Stents
Thiophenes
Thrombosis
Ticlopidine
Prasugrel Hydrochloride
Piperazines
Thiophenes
Ticlopidine

Figure

• 

  Fig. 1 At the first admission, left coronary artery angiography showed tubular eccentric 80% luminal narrowing of the mid portion of the left anterior descending artery (m-LAD) (black arrow) and tubular eccentric 90% luminal narrowing of the distal portion of left circumflex artery (d-LCx) (white arrow) (A and B). Successful percutaneous coronary intervention with stent insertion was performed on m-LAD and d-LCx (C). At the second admission, thrombi was observed in distal portion of m-LAD stent (black arrow). Also, totally occluded d-LAD lesion (narrow white arrow) and d-LCx stent (white arrow) were noted (D, E and F).

• 

  Fig. 2 At the third admission, both mid portion of the left anterior descending artery (m-LAD) (black arrow) and distal portion of left circumflex artery (d-LCx) (white arrow) stents were totally obstructed with thrombi (A and B). After the procedure, revascularization flow was recovered at both stent areas (C). In re-stent thrombosis event at the third admission, there were no flows at both stent areas in the emergency angiography (D and E). After balloon dilation on m-LAD and d-LCx stents, suboptimal revascularization flows were observed at both stents (F).

• 

  Fig. 3 The nine-month follow-up coronary angiography with prasugrel showed good patency of previous stent at mid portion of the left anterior descending artery (black arrow) and distal portion of left circumflex artery (white arrow) lesion without thrombus.

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