Recurrent coronary stent thromboses and myocardial infarctions

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Stent thrombosis is a known complication following coronary interventions.
• Recurrent stent thrombosis is an exceptionally rare clinical event.

Observation:

• A patient experienced three ST-segment elevation myocardial infarctions within six weeks due to repeated stent thromboses.
• A mechanical cause was identified for the bare-metal stent thrombosis, but no specific factors were found for the two drug-eluting stents.

Findings:

• The case underscores the risk of subacute thrombosis (1-30 days) with both BMS and DES.
• Potential contributing factors to DES thrombosis include neointimal inhibition, allergic reactions, and thienopyridine resistance.

Implications:

• This rare occurrence serves as a reminder of the potential for acute thrombotic events with modern coronary stents.
• The Food and Drug Administration advises that DES, used for on-label indications, offer a favorable risk-benefit profile.
• A minimum of one year of dual antiplatelet therapy is recommended for DES recipients at low bleeding risk.