Korean Circ J.  2007 May;37(5):230-233. 10.4070/kcj.2007.37.5.230.

Very Late Stent Thrombosis in Coronary Bare-Metal Stent Implantation: A Case Report

• Cho YS
• Jung HG
• Kim TW
• Kim KM
• Chang JH
• Rho DH
• Lee CH
• Lee JS
• Ahn BJ
• Jeong JH

• KMID: 2227069
• DOI: http://doi.org/10.4070/kcj.2007.37.5.230

Abstract

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Despite the incidence of stent thrombosis has reduced with improved techniques and drugs, stent thrombosis persists at a rate of 0.5-2% in elective cases, and up to 6% in patients with acute coronary syndromes. It almost always causes acute myocardial infarction or sudden cardiac death. While very late stent thrombosis, occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 880 days after coronary stent implantation.

Keyword

Coronary thrombosis; Stents

MeSH Terms

Acute Coronary Syndrome
Coronary Thrombosis
Death, Sudden, Cardiac
Drug-Eluting Stents
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention
Stents*
Thrombosis*

Figure

• 

  Fig. 1 AP-caudal view. The coronary angiograms on initial admission demonstrated near total occlusion of the proximal LAD. AP: anterioposterior, LAD: left anterior descending coronary artery.

• 

  Fig. 2 AP-caudal view. The post-stenting angiography showed a good appearance with TIMI 3 flow. The arrow indicated the stent deployed in the proximal LAD. AP: anterioposterior, LAD: left anterior descending coronary artery.

• 

  Fig. 3 AP-caudal views. A: the angiography showed 90% in-stent restenosis in the proximal LAD at 6 months after stent deployment. B: the postprocedural angiography after performing CBA showed good patency of the stent without restenosis. AP: anterioposterior, LAD: left anterior descending coronary artery, CBA: cutting balloon angioplasty.

• 

  Fig. 4 The follow-up coronary angiograms, six months after CBA, showed 30% ISR of the previously CBA segment of the proximal LAD. A: AP-caudal view. B: spider view. CBA: cutting balloon angioplasty, ISR: in-stent restenosis, LAD: left anterior descending coronary artery, AP: anterioposterior.

• 

  Fig. 5 The electrocardiogram showed regular sinus rhythm with Q-wave and ST segment elevation in precordial leads V1-4 at 880 days after stent deployment

• 

  Fig. 6 The coronary angiograms at 880 days after stent deployment. The coronary angiograms demonstrated a huge thrombus (arrows) in the previously stented segment of the proximal LAD. A: AP-caudal view. B: AP-cranial view. C: RAO-cranial view. D: RAO-caudal view. LAD: left anterior descending coronary artery, AP: anterioposterior, RAO: right anterior oblique.

• 

  Fig. 7 Intravascular ultrasound (IVUS) showing good expansion and apposition with mild intimal hyperplasia.

Reference

1. Wenaweser P, Rey C, Eberli FR, et al. Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome. Eur Heart J. 2005. 26:1180–1187.

2. Apostolovic S, Perisic Z, Tomasevic M, Stankovic G, Pavlovic M, Salinger-Martinovic S. Late thrombosis of coronary bare-metal stent-case report. Srp Arh Celok Lek. 2006. 134(3-4):Abstract.

3. Park DW, Park SW. Stent thrombosis in the era of the drug-eluting stent. Korean Circ J. 2005. 35:791–794.

4. Manjappa N, Agarwal A, Cavusoglu E. Very late bare-metal stent thrombosis. A case report and review of the literature. J Invasive Cardiol. 2006. 18:E203–E206.

5. Moussa I, Di Mario C, Reimers B, et al. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol. 1997. 29:6–12.

6. Stone GW, Ellis SG, Cannon L, et al. Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA. 2005. 294:1215–1223.

7. Park SH, Hong GR, Seo HS, Tahk SJ. Stent thrombosis after successful drug-eluting stent implantation. Korean Circ J. 2005. 35:163–171.

8. Katayama T, Nakashima H, Takagi C, et al. Predictors of subacute stent thrombosis in acute myocardial infarction patients following primary coronary stenting with bare-metal stent. Circ J. 2006. 70:151–155.

9. Shin DH, Kwon DA, Chung JW, et al. Late stent thrombosis after intracoronary brachytherapy: learning from brachytherapy experiences in the drug-eluting stent era. Korean Circ J. 2006. 36:324–327.

10. Choi BR, Lee CW, Park SW. Late stent thrombosis associated with late stent malapposition after drug-eluting stenting: a case report. Korean Circ J. 2006. 36:472–475.

11. Leon MB, Teirstein PS, Moses JW, et al. Localized intracoronary gamma-radiation therapy to inhibit the recurrence of restenosis after stenting. N Engl J Med. 2001. 344:250–256.

12. Parodi G, Antoniucci D. Late coronary stent thrombosis associated with exercise testing. Catheter Cardiovasc Interv. 2004. 61:515–517.

13. Lee EM, Oh DJ, Kim HC, et al. Optimal balloon inflation pressures for stent deployment-high pressure is always good. Korean Circ J. 1998. 28:1272–1279.