Acute and subacute stent thrombosis in a patient with clopidogrel resistance: a case report

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Drug-eluting stents (DES) are standard for obstructive coronary artery disease (CAD) via percutaneous intervention (PCI).
• Stent thrombosis is a concern with DES, sometimes linked to resistance to anti-platelet drugs like clopidogrel.
• Managing anti-platelet therapy in hyporesponsive patients remains a clinical challenge.

Purpose of the Study:

• To report a case of recurrent stent thrombosis in a patient with documented clopidogrel resistance.
• To illustrate the clinical course and management of such a complex case.

Main Methods:

• A 63-year-old female patient with acute myocardial infarction underwent PCI with DES implantation.
• The patient exhibited clopidogrel hyporesponsiveness and was treated with triple anti-platelet therapy (aspirin, clopidogrel, cilostazol).
• Recurrent stent thrombosis was diagnosed via coronary angiography (CAG) and treated with balloon angioplasty and glycoprotein IIb/IIIa inhibitors.

Main Results:

• The patient experienced recurrent stent thrombosis despite triple anti-platelet therapy.
• Initial PCI and subsequent balloon angioplasty for stent thrombosis were technically successful.
• The patient was discharged on continued triple anti-platelet therapy.

Conclusions:

• Recurrent stent thrombosis can occur even with aggressive anti-platelet regimens in patients with clopidogrel resistance.
• Careful monitoring and potential alternative anti-platelet strategies may be necessary for patients with DES and anti-platelet hyporesponsiveness.
• This case underscores the importance of personalized anti-platelet therapy in interventional cardiology.