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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

Coronary angiography in the first acute stent thrombosis event. A: mid left anterior descending coronary artery at the previous stented site shows total occlusion by thrombi. B: after aspiration thrombectomy and balloon angioplasty, final angiography shows Thrombolysis in Myocardial Infarction grade 3 flow.
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Figure 4: Coronary angiography in the first acute stent thrombosis event. A: mid left anterior descending coronary artery at the previous stented site shows total occlusion by thrombi. B: after aspiration thrombectomy and balloon angioplasty, final angiography shows Thrombolysis in Myocardial Infarction grade 3 flow.

Mentions: On hospital day 2, after 4 hours of stopping intravenous heparin, the patient complained of acute chest pain. ECG showed ST-segment elevation in leads V 1-6, I, and aVL, and ST-segment depression in leads III and aVF (Fig. 3). We performed CAG immediately, and it showed that mid LAD at the previous stented site was totally occluded by thrombi, which indicated acute stent thrombosis (Fig. 4A). Aspiration thrombectomy was performed using a Thrombuster® catheter (Kaneka Medix, Osaka, Japan), and percutaneous transluminal coronary angioplasty (PTCA) with 2.5×20 mm Lacrosse® (Goodman) balloon was performed with intracoronary abciximab infusion. Final angiography showed Thrombolysis in Myocardial Infarction grade 3 flow (Fig. 4B).


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)

Coronary angiography in the first acute stent thrombosis event. A: mid left anterior descending coronary artery at the previous stented site shows total occlusion by thrombi. B: after aspiration thrombectomy and balloon angioplasty, final angiography shows Thrombolysis in Myocardial Infarction grade 3 flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Coronary angiography in the first acute stent thrombosis event. A: mid left anterior descending coronary artery at the previous stented site shows total occlusion by thrombi. B: after aspiration thrombectomy and balloon angioplasty, final angiography shows Thrombolysis in Myocardial Infarction grade 3 flow.
Mentions: On hospital day 2, after 4 hours of stopping intravenous heparin, the patient complained of acute chest pain. ECG showed ST-segment elevation in leads V 1-6, I, and aVL, and ST-segment depression in leads III and aVF (Fig. 3). We performed CAG immediately, and it showed that mid LAD at the previous stented site was totally occluded by thrombi, which indicated acute stent thrombosis (Fig. 4A). Aspiration thrombectomy was performed using a Thrombuster® catheter (Kaneka Medix, Osaka, Japan), and percutaneous transluminal coronary angioplasty (PTCA) with 2.5×20 mm Lacrosse® (Goodman) balloon was performed with intracoronary abciximab infusion. Final angiography showed Thrombolysis in Myocardial Infarction grade 3 flow (Fig. 4B).

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