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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 second stent thrombosis event. A: on hospital day 7, follow-up coronary angiography shows total occlusion of the mid left anterior descending coronary artery (the previously stented lesion). B: after aspiration thrombectomy and repeated balloon angioplasty, the intraluminal filling defects (arrows) with thrombus formations persist.
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Figure 5: Coronary angiography in the second stent thrombosis event. A: on hospital day 7, follow-up coronary angiography shows total occlusion of the mid left anterior descending coronary artery (the previously stented lesion). B: after aspiration thrombectomy and repeated balloon angioplasty, the intraluminal filling defects (arrows) with thrombus formations persist.

Mentions: After successful 2nd PCI, patient's chest pain subsided with resolution of ST-segment elevation. Because IVUS findings after overlapped stenting during the index procedure did not show any mechanical complications and the level of P2Y12 Reaction Units (PRU) after stent thrombosis indicated clopidogrel resistance (P2Y12 inhibition rate was 6%), we thought that the major contributing cause of stent thrombosis was clopidogrel resistance. We added cilostazol and continued intravenous heparin infusion for 5 days. On hospital day 7, intravenous heparin infusion was stopped for discharge preparation. Approximately 4 hours after heparin discontinuation, the patient complained of similar chest pain as that he had experienced 5 days ago. ECG revealed ST-segment elevation in leads V 1-6, I, and aVL, and ST-segment depression in leads III and aVF. Repeated CAG revealed total occlusion of the stented mid LAD, with recurrent stent thrombosis (Fig. 5A). Even after thrombus aspiration and PTCA, the intraluminal filling defect persisted (Fig. 5B). We decided to perform coronary artery bypass graft (CABG) surgery because of recurrent and persistent thrombus formation. Before CABG, follow-up echocardiogram had demonstrated newly developed regional wall motion abnormalities (hypokinesia of the mid anterior septum). Emergent CABG was performed successfully by connecting the left internal mammary artery to the LAD, the saphenous vein graft to the diagonal branch, and the posterior descending artery.


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 second stent thrombosis event. A: on hospital day 7, follow-up coronary angiography shows total occlusion of the mid left anterior descending coronary artery (the previously stented lesion). B: after aspiration thrombectomy and repeated balloon angioplasty, the intraluminal filling defects (arrows) with thrombus formations persist.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Coronary angiography in the second stent thrombosis event. A: on hospital day 7, follow-up coronary angiography shows total occlusion of the mid left anterior descending coronary artery (the previously stented lesion). B: after aspiration thrombectomy and repeated balloon angioplasty, the intraluminal filling defects (arrows) with thrombus formations persist.
Mentions: After successful 2nd PCI, patient's chest pain subsided with resolution of ST-segment elevation. Because IVUS findings after overlapped stenting during the index procedure did not show any mechanical complications and the level of P2Y12 Reaction Units (PRU) after stent thrombosis indicated clopidogrel resistance (P2Y12 inhibition rate was 6%), we thought that the major contributing cause of stent thrombosis was clopidogrel resistance. We added cilostazol and continued intravenous heparin infusion for 5 days. On hospital day 7, intravenous heparin infusion was stopped for discharge preparation. Approximately 4 hours after heparin discontinuation, the patient complained of similar chest pain as that he had experienced 5 days ago. ECG revealed ST-segment elevation in leads V 1-6, I, and aVL, and ST-segment depression in leads III and aVF. Repeated CAG revealed total occlusion of the stented mid LAD, with recurrent stent thrombosis (Fig. 5A). Even after thrombus aspiration and PTCA, the intraluminal filling defect persisted (Fig. 5B). We decided to perform coronary artery bypass graft (CABG) surgery because of recurrent and persistent thrombus formation. Before CABG, follow-up echocardiogram had demonstrated newly developed regional wall motion abnormalities (hypokinesia of the mid anterior septum). Emergent CABG was performed successfully by connecting the left internal mammary artery to the LAD, the saphenous vein graft to the diagonal branch, and the posterior descending artery.

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