J Lipid Atheroscler.  2014 Jun;3(1):43-48. 10.12997/jla.2014.3.1.43.

Acute Stent Thrombosis after Coronary Stenting in Patients with Acute Coronary Syndrome

• Shin HS
• Kim SH
• Kim HL
• Seo JB
• Chung WY
• Zo JH
• Kim MA

• KMID: 2198360
• DOI: http://doi.org/10.12997/jla.2014.3.1.43

Abstract

Acute stent thrombosis after percutaneous coronary intervention (PCI) is still problematic because of the subsequent development of myocardial infarction and poor prognosis. The incidence of acute stent thrombosis, occurring within 0-24hours after PCI, is relatively low, but underlying causes and treatment strategy are not well defined. Multi-vessel disease, ST-elevated myocardial infarction (STEMI), and large thrombotic burden are known risk factors of acute stent thrombosis. Thrombus aspiration, balloon angioplasty and glycoprotein IIb/IIIa receptor blocker could be therapeutic options. Recently we experienced two cases of acute stent thrombosis which developed during PCI with the aggravation of chest pain, and acute stent thrombosis were diagnosed immediately and successfully treated. Here we report two cases of acute stent thrombosis during PCI for one patient with STEMI and the other with acute coronary syndrome, which were successfully treated with thrombus aspiration and intravenous infusion of glycoprotein IIb/IIIa receptor blocker.

Keyword

Coronary thrombosis; Acute coronary syndrome; Abciximab

MeSH Terms

Acute Coronary Syndrome*
Angioplasty, Balloon
Chest Pain
Coronary Thrombosis
Glycoproteins
Humans
Incidence
Infusions, Intravenous
Myocardial Infarction
Percutaneous Coronary Intervention
Prognosis
Risk Factors
Stents*
Thrombosis*
Glycoproteins

Figure

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  Fig. 1 Initial electrocardiogram showed ST-segment elevation in leads I, avL, V1, V2, V3, V4 with reciprocal changes of ST-segment in leads II, III, and aVF.

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  Fig. 2 Initial chest X-ray showed bilateral pulmonary edema.

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  Fig. 3 (A) Left anterior oblique (LAO) projection with caudal angulation of selective left coronary angiogram showed the total occlusion with thrombus in the proximal part of left anterior descending artery (arrows), (B) LAO projection with cranial angulation of selective left CAG. Everolimus eluting stent (3.0×18 mm Xience V stent, Abbott, USA) was successfully placed in the LAD (arrows), (C) Right anterior oblique projection with cranial angulation of selective left CAG after RCA treatment showed intraluminal filling defect of the targeted lesion of LAD (arrows), (D) After thrombus aspiration and infusion of glycoprotein IIb/IIIa receptor blocker, CAG showed recovery of coronary flow.

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  Fig. 4 (A) Right anterior oblique (RAO) projection with caudal angulation of selective left coronary angiogram showed the long segmental concentric stenosis in proximal to middle LAD and total occlusion in proximal LCX (arrows), (B) LAO projection with cranial angulation of selective left CAG. Two Everolimus eluting stents (2.5×28 mm and 3.0×23 mm Xience V stent, Abbott) were inserted in proximal and middle LAD, (C) LAO projection with cranial angulation of selective left CAG after LCX treatment showed intraluminal filling defect of the distal LAD (arrows), (D) After thrombus aspiration, infusion of glycoprotein IIb/IIIa receptor blocker and balloon angioplasty, CAG showed recovery of coronary flow.

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