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Published on: May 14, 2013
Acute multi-vessel coronary stent thrombosis
Matthew W Lawrence1, Michael J Matteucci, Luthur I Carter
1Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California 92134-5000, USA.
Insights
Acute stent thrombosis is a rare but serious complication after coronary artery stenting. Even with adherence to dual anti-platelet therapy, prompt recognition and intervention are crucial for managing this life-threatening event.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Coronary artery stent thrombosis is a rare, potentially fatal complication of percutaneous coronary intervention (PCI).
- Dual anti-platelet therapy (aspirin plus clopidogrel) is standard but does not eliminate risk.
- Stent thrombosis can lead to acute coronary syndromes.
Observation:
- A 52-year-old male presented with chest pain hours after PCI with drug-eluting stents in two vessels.
- He experienced dynamic ECG changes and elevated cardiac markers despite adhering to prescribed anti-platelet therapy.
- Urgent repeat catheterization showed complete thrombotic occlusion of both previously stented coronary arteries.
Findings:
- Acute stent thrombosis occurred despite full compliance with recommended dual anti-platelet therapy.
- Premature cessation of anti-platelet therapy is a significant risk factor.
- This case highlights the potential for thrombosis in multiple stented vessels.
Implications:
- Emergency physicians must maintain a high index of suspicion for stent thrombosis.
- Current anti-platelet guidelines require careful consideration in managing post-PCI patients.
- Prompt diagnosis and intervention are critical for improving outcomes in acute stent thrombosis.
Background:
Coronary artery stent thrombosis is a rare but often fatal complication associated with percutaneous coronary intervention (PCI) using both bare-metal stents and drug-eluting stents. Although strict adherence to dual anti-platelet therapy (aspirin plus clopidogrel) minimizes this risk, stent thrombosis will still occur in rare patients, leading to acute, subacute, or late life-threatening acute coronary syndromes.
Objectives:
To present a rare case of acute stent thrombosis involving multiple vessels to increase awareness of this life-threatening condition among emergency physicians, and to review the current guidelines for anti-platelet therapy in this patient population.
Case Report:
A 52-year-old man who underwent PCI using drug-eluting stents in two separate coronary vessels presented to the Emergency Department within 2 h of discharge from the hospital with chest pain, dynamic electrocardiogram changes, and elevated cardiac markers. Despite compliance with the current recommendations for post-PCI anti-platelet therapy, urgent repeat catheterization revealed total thrombotic occlusion of both stents, requiring urgent repeat intervention.
Conclusion:
Despite patient compliance with the currently recommended anti-platelet regimen after stent therapy for coronary artery disease, acute stent thrombosis remains a rare but life-threatening risk in both the immediate and delayed post-intervention period. In addition, premature cessation of this anti-platelet therapy stands as the greatest risk factor for such thrombotic events. This case is presented to inform emergency physicians of the current post-PCI anticoagulation recommendations to help mitigate the risk of such complications.
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