Late bare metal stent thrombosis.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Late stent thrombosis (LST) is a rare but serious complication following percutaneous coronary intervention (PCI).
• Bare metal stents (BMS) are associated with a lower risk of LST compared to drug-eluting stents, but it can still occur.
• Discontinuation of antiplatelet therapy is a known risk factor for stent thrombosis.

Observation:

• A 72-year-old male presented with cardiogenic shock 350 days post-PCI of the left main coronary artery (LMCA) with a BMS.
• Coronary angiography revealed total occlusion of the LMCA BMS and critical stenosis in the right coronary artery.
• The patient had temporarily discontinued aspirin and clopidogrel (dual antiplatelet therapy) prior to and following a recent urological procedure.

Findings:

• Despite successful revascularization of the LMCA and right coronary artery, the patient developed cardiac arrest and died.
• The timing of antiplatelet therapy discontinuation in relation to the urological surgery and subsequent PCI is a key factor in this case.
• This case underscores the potential for late stent thrombosis in BMS, particularly in the context of interrupted antiplatelet therapy.

Implications:

• Premature discontinuation of dual antiplatelet therapy poses a significant risk for stent thrombosis, even with bare metal stents.
• Careful management of antiplatelet therapy around surgical procedures is crucial in patients with coronary stents.
• This case highlights the need for heightened vigilance regarding stent thrombosis in patients with risk factors, including recent surgery and interrupted antiplatelet therapy.