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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 - Korean Circ J (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: Clinical diagnosis of acute non-ST elevation myocardial infarction (MI) was made. We performed coronary angiography (CAG) with intravenous heparin infusion, and 300 mg of aspirin and 600 mg of clopidogrel were given. CAG revealed near total occlusion of the mid left anterior descending coronary artery (LAD) and significant stenosis of the mid right coronary artery (Fig. 2A and B). PCI was performed for revascularization of the mid LAD. Because the laboratory findings showed microcytic hypochromic anemia (Hb 9.8 g/dL), we decided to use the bare metal stent. After balloon predilation, a 2.75×23 mm Genous® stent (OrbusNeich, Hoevelaken, The Netherlands) was placed in the mid LAD with adjunctive high pressure ballooning using Powered Lacrosse® 2.5×10 mm (Goodman, Nagoya, Japan). After high pressure ballooning, follow-up angiography and intravascular ultrasound (IVUS; Boston Scientific, MA, USA) showed minor dissection at the distal stent edge. We therefore performed additional overlapping stenting using a 2.5×23 mm Genous® stent; the procedure was successful without any angiographic complications and final IVUS did not show dissection, or stent malapposition, or stent underexpansion (Fig. 2C and D).


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 - Korean Circ J (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310983&req=5

Figure 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.
Mentions: Clinical diagnosis of acute non-ST elevation myocardial infarction (MI) was made. We performed coronary angiography (CAG) with intravenous heparin infusion, and 300 mg of aspirin and 600 mg of clopidogrel were given. CAG revealed near total occlusion of the mid left anterior descending coronary artery (LAD) and significant stenosis of the mid right coronary artery (Fig. 2A and B). PCI was performed for revascularization of the mid LAD. Because the laboratory findings showed microcytic hypochromic anemia (Hb 9.8 g/dL), we decided to use the bare metal stent. After balloon predilation, a 2.75×23 mm Genous® stent (OrbusNeich, Hoevelaken, The Netherlands) was placed in the mid LAD with adjunctive high pressure ballooning using Powered Lacrosse® 2.5×10 mm (Goodman, Nagoya, Japan). After high pressure ballooning, follow-up angiography and intravascular ultrasound (IVUS; Boston Scientific, MA, USA) showed minor dissection at the distal stent edge. We therefore performed additional overlapping stenting using a 2.5×23 mm Genous® stent; the procedure was successful without any angiographic complications and final IVUS did not show dissection, or stent malapposition, or stent underexpansion (Fig. 2C and D).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus