[Non cardiac surgery in patient with coronary stenting: think sirolimus now!]

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Cardiogenic shock is a life-threatening condition often requiring immediate intervention.
• Sirolimus-eluting stents are commonly used for coronary artery disease but carry a risk of thrombosis.
• Preoperative cardiogenic shock in patients undergoing non-cardiac surgery is rare and poses significant management challenges.

Observation:

• A patient presented with severe cardiogenic shock prior to scheduled breast surgery.
• The shock was attributed to acute thrombosis of two sirolimus-eluting stents implanted three months earlier.
• This clinical scenario highlights a critical intersection of cardiovascular events and elective surgical procedures.

Findings:

• Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed to address the stent thrombosis.
• The patient received intensive medical management, including intra-aortic balloon counter pulsation and dobutamine infusion.
• Recovery was rapid, with the patient responding well to the 1-day treatment regimen.

Implications:

• The case underscores the importance of carefully considering the timing of elective surgery in patients with recent coronary stent placement.
• Optimal management strategies for shifting antiplatelet therapy in this high-risk population require further discussion and consensus.
• This case provides valuable insights into managing complex cardiovascular complications in the perioperative setting.