Acute two-vessel occlusion due to simultaneous very late stent thrombosis following sirolimus-eluting stent implantation: a case report and review of the literature

摘要

Introduction Very late stent thrombosis (VLST; > 1 year) is a rare but fatal complication due to acute vessel closure. Several factors, including procedure, lesion and patient discontinuation of antiplatelet therapy, are most closely related to its occurrence [1]. Furthermore, neoatherosclerotic plaque rupture is now acknowledged as a potential contributing factor [2]. Although similar rates of early and late stent thrombosis were observed between drug-eluting stent (DES) and bare metal stent (BMS) [3]. Very late stent thrombosis occurs with higher frequency in DES [4]. However, it is even rarer to have a simultaneous two-vessel very late stent thrombosis with a sirolimus-eluting stent (SES), and studies on the pathogeny are lacking. We report the case of a patient presenting with ST-segment-elevation myocardial infarction (STEMI) and cardiogenic shock who experienced simultaneous VLST in two vessels which occurred 40 months after sirolimus-eluting stent implantation. Case report A 56-year-old man presented to the emergency department with severe chest pain within 4 h after onset of symptoms. The ECG showed an ST-segment elevation in I, aVL and V6–V9 (Figure 1). The patient had undergone percutaneous coronary intervention (PCI) in our catheter lab using sirolimus-eluting stents (Firebird, MicroPort) in the left anterior descending (LAD) (3.0 × 33 mm; 16 atm) and in the left circumflex artery (LCX) (2.75 × 33 mm; 10 atm) 40 months prior to admission. Also, 35 months prior to admission, an intervention in a de novo lesion of the right coronary artery (RCA) using an SES (Firebird, MicroPort; 4.0 × 23 mm; 9 atm) followed by balloon angioplasty was performed. At this point in time, no evidence of restenosis was found in the former lesion of the LAD or LCX. Anti-platelet therapy consisting of 100 mg aspirin and 75 mg clopidogrel was prescribed for an intended period of 12 months following percutaneous intervention. Cardiac catheterization revealed a thrombotic occlusion at the site of the stent implanted in the LAD as well as at the site of the stent in the LCX (Figure 2 A). A temporary pacemaker was inserted, then crossing the lesions of LCX with a guidewire, thrombus aspiration was performed using a thrombus aspiration device (Thrombuster II, KANEKA) starting in the LCX. Intracoronary abciximab followed by intravenous infusion was administered. The angiographic result showed Thrombolysis In Myocardial Infarction (TIMI) 3... View full text...