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Very late stent thrombosis: simultaneous two-arterial occlusions
Hana Vaknin-Assa1, Zaza Iakobishvili, Ran Kornowski
1Division of Interventional Cardiology and Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Summary
Very late dual Cypher stent thrombosis caused acute myocardial infarction and cardiogenic shock. Emergent resuscitation and angioplasty successfully treated this rare cardiac event.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Drug-eluting stents (DES) are widely used to prevent restenosis after percutaneous coronary intervention.
- Cypher stents, a type of sirolimus-eluting stent, have been associated with late stent thrombosis in some cases.
- Very late stent thrombosis (VLST) is a rare but serious complication occurring >1 year after stent implantation.
Observation:
- A patient presented with a massive acute myocardial infarction and cardiogenic shock.
- Diagnostic workup revealed very late dual Cypher stent thrombosis as the cause.
- The patient had no prior history of stent thrombosis or adverse events.
Findings:
- VLST in dual Cypher stent configurations is an uncommon clinical scenario.
- Massive myocardial infarction and cardiogenic shock were directly attributed to the thrombotic event.
- Successful management involved emergent resuscitation and prompt angioplasty.
Implications:
- This case highlights the potential for rare thrombotic complications even with established DES.
- Vigilance for VLST is crucial in patients with a history of Cypher stent implantation.
- Timely intervention with angioplasty is critical for managing acute myocardial infarction secondary to VLST.
