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Late acute thrombosis after paclitaxel eluting stent implantation
1Cardiac Catheterisation Laboratory, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. francescoliistro@hotmail.com
Insights
Late total occlusion after coronary stenting can occur over six months post-procedure. This case highlights a thrombotic event after paclitaxel drug-eluting stent implantation, suggesting ongoing risks.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Late total occlusion (LTO) after coronary stenting, typically >6 months, affects ~4% of patients, often due to intimal hyperplasia.
- Coronary stenting with brachytherapy has shown higher LTO rates, linked to stent thrombosis rather than hyperplasia.
- Paclitaxel drug-eluting stents (DES) are widely used to reduce restenosis.
Observation:
- A case of LTO presenting with an acute clinical event seven months after paclitaxel-eluting stent implantation.
- The occlusion occurred shortly after the interruption of ticlopidine treatment, an antiplatelet medication.
Findings:
- The clinical presentation and timing suggest a thrombotic genesis for the LTO, challenging the assumption of intimal hyperplasia as the sole cause.
- This case indicates that the risk of stent thrombosis leading to LTO may extend beyond the initial six-month period post-DES implantation.
Implications:
- The findings suggest that prolonged antiplatelet therapy might be crucial even after six months in specific patient subsets with DES.
- Further research is needed to understand the mechanisms and risk factors for late stent thrombosis and LTO after DES implantation.
- This case underscores the importance of considering thrombotic events in the differential diagnosis of late stent failure.
Abstract:
Late (more than six months) total occlusion after coronary stenting is a progressive phenomenon occurring in approximately 4% of patients, leading to acute myocardial infarction in less than 0.5%. The process must be related to severe and progressive intimal hyperplasia. In patients receiving coronary stenting with simultaneous brachytherapy, late total occlusion has been reported at a higher rate and to be related to stent thrombosis rather than intimal hyperplasia. Late total occlusion presenting with an acute clinical event seven months after the implantation of a paclitaxel drug eluting stent is reported. The occlusion developed soon after the interruption of ticlopidine treatment, suggesting that the event had a thrombotic genesis and that the risk is not confined to the first six month period.