[Late stent thrombosis]

Late stent thrombosis is a serious complication after stent implantation and it can lead to the development of acute myocardial infarction or death.

A 43-year-old patient was admitted to our clinic to coronary care unit. He was diagnosed with acute ST elevation myocardial reinfarction of inferoposterior localization and with right ventricular myocardial infarction. Eighteen months ago, he had acute myocardial infarction of the same localization, and at the same time, PCI (Percutaneous Coronary Intervention) was performed in acute phase, and two bare metal stents were implanted. Now, the patient had chest discomfort two hours before admittance, and PCI was performed once again in acute phase. The diagnostic coronarography resulted in occlusion of the right coronary artery, on the spot of the previously implanted stents. After the passage of guidewire, the artery was recanalized, and defects of artery opacification, which might have been thrombs, were noticed. The thrombs were seen on the spots of earlier implanted stents and in the posterior inteventricular and posterolateral branches of the right coronary artery. PTCA was performed and the patient received the GP IIb/IIIa antagonist therapy after which the control coronarography showed minimal defects of artery opacification, with good anterograde flow. After complete treatment the patient was in good condition.

Late stent thrombosis, although not very often, is a very serious complication and can lead to death or acute myocardial infarction. To prevent it, it is necessary that the patient receives dual antiplatelet therapy, and that PCI procedure is performed technically correctly (suitable stent dimensions and proper stent expansion).