Korean Circ J.  2015 Jan;45(1):71-76. 10.4070/kcj.2015.45.1.71.

Recurrent Stent Thrombosis in a Patient with Antiphospholipid Syndrome and Dual Anti-Platelet Therapy Non-Responsiveness

• Lee YH
• Yang HM
• Tahk SJ
• Hong YS
• Park JS
• Seo KW
• Choi YW
• Noh CK

• KMID: 2223849
• DOI: http://doi.org/10.4070/kcj.2015.45.1.71

Abstract

Antiphospholipid syndrome (APS), the most common acquired hypercoagulable condition, is diagnosed by persistent presence of antiphospholipid antibodies and episodes of vascular thrombosis. It may be an important predisposing factor for stent thrombosis, resulting in poor outcomes. Also, anti-platelet therapy non-responsiveness is associated with stent thrombosis. We report a case of a 39-year-old man who after undergoing successful percutaneous coronary intervention for significant coronary artery disease suffered repeated stent thrombosis events leading to ST-segment elevation myocardial infarction. Eventually, he underwent coronary artery bypass surgery because of uncontrolled thrombosis and was diagnosed as having APS and dual antiplatelet therapy non-responsiveness.

Keyword

Antiphospholipid syndrome; Percutaneous coronary intervention; Stents; Thrombosis

MeSH Terms

Adult
Antibodies, Antiphospholipid
Antiphospholipid Syndrome*
Causality
Coronary Artery Bypass
Coronary Artery Disease
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Stents*
Thrombosis*
Antibodies, Antiphospholipid

Figure

• 

  Fig. 1 Initial electrocardiogram. Electrocardiogram shows ST-segment depression in leads V 3-5 and flattened T wave in leads II, III, and aVF.

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  Fig. 2 Initial coronary angiography. A: left coronary angiography shows near total occlusion of the mid left anterior descending coronary artery and intermediate stenosis of the left circumflex coronary artery. B: right coronary artery shows significant stenosis at the mid portion. C: after stent implantation, coronary angiography shows a successful result. D: final intravascular ultrasound finding after overlapping stent does not show dissection, or stent malapposition, or stent underexpansion.

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  Fig. 3 Electrocardiogram during the first stent thrombosis event. Electrocardiogram showed ST-segment elevation in leads V 1-6, I, and aVL, and ST-segment depression in leads III and aVF.

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  Fig. 4 Coronary angiography in the first acute stent thrombosis event. A: mid left anterior descending coronary artery at the previous stented site shows total occlusion by thrombi. B: after aspiration thrombectomy and balloon angioplasty, final angiography shows Thrombolysis in Myocardial Infarction grade 3 flow.

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  Fig. 5 Coronary angiography in the second stent thrombosis event. A: on hospital day 7, follow-up coronary angiography shows total occlusion of the mid left anterior descending coronary artery (the previously stented lesion). B: after aspiration thrombectomy and repeated balloon angioplasty, the intraluminal filling defects (arrows) with thrombus formations persist.

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