Acute multi-vessel coronary stent thrombosis.

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.