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Successful prasugrel rescue therapy in clopidogrel resistant patients who had recurrent stent thrombosis of drug-eluting-stent: the role of prasugrel in clopidogrel nonresponders.

Lee SH, Kim BK, Oh J, Park JS, Lee DJ, Lee HC, Kim JH, Hong MK - Korean Circ J (2013)

Bottom Line: Stent thrombosis is a very serious problem after drug-eluting stent (DES) implantation even though its incidence is about or less than 1%.As the clopidogrel resistance is expected to play an important role in the occurrence of stent thrombosis, new anti-platelet agents overcoming this issue can give us another choice.We experienced a case of a 58-year-old male with successful prasugrel rescue therapy in a patient with clopidogrel resistance who had recurrent stent thrombosis following DES implantation.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Stent thrombosis is a very serious problem after drug-eluting stent (DES) implantation even though its incidence is about or less than 1%. As the clopidogrel resistance is expected to play an important role in the occurrence of stent thrombosis, new anti-platelet agents overcoming this issue can give us another choice. We experienced a case of a 58-year-old male with successful prasugrel rescue therapy in a patient with clopidogrel resistance who had recurrent stent thrombosis following DES implantation.

No MeSH data available.


Related in: MedlinePlus

At the third admission, both mid portion of the left anterior descending artery (m-LAD) (black arrow) and distal portion of left circumflex artery (d-LCx) (white arrow) stents were totally obstructed with thrombi (A and B). After the procedure, revascularization flow was recovered at both stent areas (C). In re-stent thrombosis event at the third admission, there were no flows at both stent areas in the emergency angiography (D and E). After balloon dilation on m-LAD and d-LCx stents, suboptimal revascularization flows were observed at both stents (F).
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Figure 2: At the third admission, both mid portion of the left anterior descending artery (m-LAD) (black arrow) and distal portion of left circumflex artery (d-LCx) (white arrow) stents were totally obstructed with thrombi (A and B). After the procedure, revascularization flow was recovered at both stent areas (C). In re-stent thrombosis event at the third admission, there were no flows at both stent areas in the emergency angiography (D and E). After balloon dilation on m-LAD and d-LCx stents, suboptimal revascularization flows were observed at both stents (F).

Mentions: However, he visited the emergency room again on Jan 2011 because of a severe ongoing chest pain. Electrocardiogram showed ST elevation (>1 mm) on the anterior (V 1-3) lead. Emergency coronary angiography was performed and both m-LAD and d-LCx stents were totally obstructed on the angiogram (Fig. 2A and B). Thrombus aspiration (Thrombuster II; Kaneka Medix Corporation, Osaka, Japan) and balloon dilation with 3.0×15 mm-sized balloon were performed on both m-LAD and d-LCx stents (Fig. 2C). Because of the drop of blood pressure during the procedure (80/50 mm Hg), intraaortic balloon pump (AutoCAT2 WAVE-Fiber Optic; Arrow International Inc., Reading, PA, USA) and percutaneous cardiopulmonary support (CAPIOX EBS; Terumo Corporation, Tokyo, Japan) were applied. Transthoracic echocardiogram was performed right after the procedures showed a reduced left ventricular ejection fraction of 25% with anterior and anteroseptal wall akinesis. Triple antiplatelet therapy was conducted again. After that, the patient was stable and all the other devices were removed; he was sent to the general ward. However, thirteen days post procedure, he experienced a severe resting pain again. The resting electrocardiogram showed a ST segment elevation on V 1-6 leads. On the emergency angiogram, previously treated LAD and LCx stents were occluded again (Fig. 2D and E).


Successful prasugrel rescue therapy in clopidogrel resistant patients who had recurrent stent thrombosis of drug-eluting-stent: the role of prasugrel in clopidogrel nonresponders.

Lee SH, Kim BK, Oh J, Park JS, Lee DJ, Lee HC, Kim JH, Hong MK - Korean Circ J (2013)

At the third admission, both mid portion of the left anterior descending artery (m-LAD) (black arrow) and distal portion of left circumflex artery (d-LCx) (white arrow) stents were totally obstructed with thrombi (A and B). After the procedure, revascularization flow was recovered at both stent areas (C). In re-stent thrombosis event at the third admission, there were no flows at both stent areas in the emergency angiography (D and E). After balloon dilation on m-LAD and d-LCx stents, suboptimal revascularization flows were observed at both stents (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3675310&req=5

Figure 2: At the third admission, both mid portion of the left anterior descending artery (m-LAD) (black arrow) and distal portion of left circumflex artery (d-LCx) (white arrow) stents were totally obstructed with thrombi (A and B). After the procedure, revascularization flow was recovered at both stent areas (C). In re-stent thrombosis event at the third admission, there were no flows at both stent areas in the emergency angiography (D and E). After balloon dilation on m-LAD and d-LCx stents, suboptimal revascularization flows were observed at both stents (F).
Mentions: However, he visited the emergency room again on Jan 2011 because of a severe ongoing chest pain. Electrocardiogram showed ST elevation (>1 mm) on the anterior (V 1-3) lead. Emergency coronary angiography was performed and both m-LAD and d-LCx stents were totally obstructed on the angiogram (Fig. 2A and B). Thrombus aspiration (Thrombuster II; Kaneka Medix Corporation, Osaka, Japan) and balloon dilation with 3.0×15 mm-sized balloon were performed on both m-LAD and d-LCx stents (Fig. 2C). Because of the drop of blood pressure during the procedure (80/50 mm Hg), intraaortic balloon pump (AutoCAT2 WAVE-Fiber Optic; Arrow International Inc., Reading, PA, USA) and percutaneous cardiopulmonary support (CAPIOX EBS; Terumo Corporation, Tokyo, Japan) were applied. Transthoracic echocardiogram was performed right after the procedures showed a reduced left ventricular ejection fraction of 25% with anterior and anteroseptal wall akinesis. Triple antiplatelet therapy was conducted again. After that, the patient was stable and all the other devices were removed; he was sent to the general ward. However, thirteen days post procedure, he experienced a severe resting pain again. The resting electrocardiogram showed a ST segment elevation on V 1-6 leads. On the emergency angiogram, previously treated LAD and LCx stents were occluded again (Fig. 2D and E).

Bottom Line: Stent thrombosis is a very serious problem after drug-eluting stent (DES) implantation even though its incidence is about or less than 1%.As the clopidogrel resistance is expected to play an important role in the occurrence of stent thrombosis, new anti-platelet agents overcoming this issue can give us another choice.We experienced a case of a 58-year-old male with successful prasugrel rescue therapy in a patient with clopidogrel resistance who had recurrent stent thrombosis following DES implantation.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Stent thrombosis is a very serious problem after drug-eluting stent (DES) implantation even though its incidence is about or less than 1%. As the clopidogrel resistance is expected to play an important role in the occurrence of stent thrombosis, new anti-platelet agents overcoming this issue can give us another choice. We experienced a case of a 58-year-old male with successful prasugrel rescue therapy in a patient with clopidogrel resistance who had recurrent stent thrombosis following DES implantation.

No MeSH data available.


Related in: MedlinePlus