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Subacute Coronary Stent Thrombosis in Patient after Elective Percutaneous Coronary Intervention : Causes, Risk Factors and Management

Author : A. Chairunnisa, A. Wardhani, Y. Herry, I. Uddin, Safir
Upload Date : 19-04-2018

Background: Stent thrombosis (ST) is a rare but life-threatening complication of coronary intervention. Severe chest pain, shortness of breath, malignant arrhythmia are typical symptoms of acute ST. The incidence varies between 0.1-1.7%, and can cause acute myocardial infarction up to 50-80% and mortality >45%.

 Case Presentation: A 71 years old man who has undergone elective PCI 8 days ago because of CAD 2VD with CTO in RCA (PCI with 2 stent DES in LAD) came to emergency room with severe chest pain, cold sweat, nausea and vomit since 1 hour before admission. The ECG showed ST elevation in lead V1-V6, diagnosed with acute anterior myocardial infarction. He admit didn’t consume DAPT in last 3 days. Angiography showed total occlusion in stent thrombosis in mid LAD. During primary PCI, he was given GP IIb/IIIa inhibitor and insertion of 1 stent DES in LAD. He was diagnosed with prostate cancer 2 years ago. Chest X-Ray and MSCT showed possibility of lung cancer. Because of high possibility for ST, DAPT therapy was switch to more potent P2Y12 antagonist.

Discussion: Diagnosis of ST is usually made by coronary angiography evidence, presenting with a thrombus that originates in the stent segment or in the 5 mm proximal or distal to the stent with or without vessel occlusion which is associated with acute ischemic symptoms and ECG signs. Predictors of ST including intra/post procedural, lesion-related, patient-related, and anti-platelet therapy factors. There are several risks for ST in this patient : long stent length, LAD stent, small vessel, long lesion, hypercoagulable state of malignancy, older age, decreased LVEF, and premature discontinuation of DAPT. Further investigation is needed to determine clopidogrel resistance. 

Conclusion: In patient with high possibility for ST, education for continuing DAPT in 12 months is very important because of fatal complication. After ST, DAPT should be considered of more potent P2Y12 antagonist.

KEYWORDS : stent thrombosis, acute myocardial infarction

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