Acute stent thrombosis in a patient with giant cell arteritis

A 70-year-old man presented with a non-ST elevation myocardial infarction attributable to a 99% occlusion of his mid-left anterior descending artery and concomitant symptoms suggestive of giant cell arteritis. He underwent bare metal stenting, with an excellent angiographic result, and was placed on dual antiplatelet therapy, as well as oral prednisone 30 mg twice daily, while awaiting confirmatory temporal artery biopsy. Unfortunately, 70 h after percutaneous coronary intervention, he developed acute stent thrombosis. Platelet aggregometry demonstrated that he was responsive to acetylsalicylic acid, but marginally responsive to clopidogrel. Over the next 30 days, he had a marked clinical improvement, with an improvement in platelet response to clopidogrel that paralleled the clinical resolution of his vasculitis. The present case reports the first incidence of acute stent thrombosis associated with giant cell arteritis, and suggests that the proinflammatory milieu of acute inflammatory arthritides may warrant prolonged, aggressive antiplatelet therapy in the setting of an acute coronary syndrome.