Definite Sub Acute Stent Thrombosis after Primary Percutaneous Coronary Intervention

Author : G.Aditya, W. Aryadana
Upload Date : 19-04-2018

Introduction: Stent thrombosis (ST) is uncommon yet constitutes the most feared complication following percutaneous coronary intervention (PCI). The incidence of ST varies between 0.3-2.8%. The majority of cases with ST are complicated by critical consequences, including myocardial infarction (MI) and even sudden cardiac death.

Case Illustration:  A-61-year-old man, with typical chest pain lasting thirty minutes before admission. He has history of heart attack one week before and said that he took medication regularly. His physical examination was normal. Electrocardiography showed sinus rhythm with concave ST elevation at lead V1-V6, I and aVL. Laboratory examination showed cardiac marker elevation. He has done primary PCI one week before readmitted with CAD/3 vessel disease, two stents implanted at LAD proximal until mid. Patient diagnosed with STEMI Anterior Extensive and planned for primary PCI. Angiography showed thrombus at stented LAD, POBA was done at osteal until distal LAD and additional stent implanted at distal LAD.

Discussion: Early ST is further divided into acute (≤24 hours) and sub acute (>24 hours–30 days). Mechanisms and pathophysiology leading to ST can be classified into four major categories: i) patient-related, ii) lesion-related, iii) procedure-related, and iv) medication (post-stenting)-related. For early ST, lesion and procedure-related risk factors are relatively more important. Risk factor for ST in this patient was acute coronary syndrome, smoking, decrease EF (LVEF 41%), and ethnic Asian which has higher incidence of CYP2C19 polymorphism. ST patient was treated with percutaneous coronary intervention, balloon angioplasty and or additional stent implantation, and GP IIb/IIIa inhibitor.

Conclusion: ST Elevation MI caused by sub acute stent thrombosis should be considered if MI happened after stent implantation. To avoid this most critical complication of PCI, establishment of revascularization strategies in accordance with the complexity of patients and lesions, post-dilatation for good stent apposition and selection of appropriate antiplatelet agents are needed.

KEYWORDS : Sub Acute Stent Thrombosis, Percutaneous Coronary Intervention, Acute Coronary Syndrome

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