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[Coronary artery bypass grafting for simultaneous subacute stent thrombosis after sirolimus-eluting stent
Mitsuaki Matsumoto1, K Suehiro, Y Kubo
1Department of Cardiovascular Surgery, Tsuyama Chuo Hospital, Tsuyama, Japan.
Insights
This case report details a life-threatening event of simultaneous sirolimus-eluting stent thrombosis in multivessel coronary lesions. The patient recovered after coronary artery bypass grafting, highlighting potential risks with certain antiplatelet regimens.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Subacute stent thrombosis remains a significant complication following percutaneous coronary intervention (PCI).
- Sirolimus-eluting stents (SES) are widely used, but thrombosis can occur, especially in complex cases.
- Optimal antiplatelet therapy after stent implantation is crucial for preventing thrombotic events.
Observation:
- An 82-year-old male experienced simultaneous stent thrombosis in the left anterior descending and right coronary arteries 11 days after SES implantation.
- The patient developed recurrent stent thrombosis despite initial PCI, necessitating emergency coronary artery bypass grafting.
- A history of ticlopidine-induced liver dysfunction led to the omission of thienopyridine therapy, with aspirin, cilostazol, and sarpogrelate used instead.
Findings:
- Postoperative angiography confirmed graft patency and absence of in-stent thrombus after bypass surgery.
- The patient's condition improved significantly with aspirin monotherapy post-operatively.
- The absence of thienopyridine therapy was implicated as the primary cause of subacute stent thrombosis.
Implications:
- Simultaneous SES thrombosis in multivessel disease is a critical, life-threatening complication.
- This case underscores the importance of tailored antiplatelet strategies, especially in patients with contraindications to standard therapies.
- Careful consideration of alternative antiplatelet agents is necessary to mitigate thrombosis risk in high-risk patients.
Abstract:
An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.
