Korean Circ J.  2011 Jul;41(7):417-420. 10.4070/kcj.2011.41.7.417.

Very Late Stent Thrombosis in a Drug-Eluting Stent due to Interruption of Anti-Platelet Agents in Patients With Acute Myocardial Infarction and Thrombocytosis

• Choi HS
• Jeong MH
• Seo IK
• Lee MG
• Ko JS
• Park KH
• Sim DS
• Yoon NS
• Kim KH
• Park HW
• Hong YJ
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 2225109
• DOI: http://doi.org/10.4070/kcj.2011.41.7.417

Abstract

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy.

Keyword

Drug-eluting stents; Thrombosis; Essential thrombocythemia

MeSH Terms

Drug-Eluting Stents
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Risk Factors
Stents
Thrombocythemia, Essential
Thrombocytosis
Thrombosis

Figure

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  Fig. 1 Patient underwent percutaneous coronary intervention (PCI) in the right coronary artery (RCA) due to inferior ST elevation myocardial infarction two and a half years ago. Initial coronary angiogram revealed critical stenosis in middle RCA (95%) and distal left circumflex artery (LCX) (80%) (A and C). We deployed bare metal stent in the proximal and middle RCA (B), and drug-eluting stent in the distal LCX by staged PCI (D).

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  Fig. 2 Electrocardiogram showed ST-segment elevation in lead II, III and aVF.

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  Fig. 3 Emergent coronary angiogram showed thrombotic total occlusion of the distal left circumflex artery due to drug-eluting stent thrombosis (A), and patent right coronary artery bare metal stent (B).

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  Fig. 4 Coronary angiogram after balloon dilatation showed no residual stenosis and relatively good distal flow.

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