Very late stent thrombosis occurring simultaneously in sirolimus-eluting stents and bare-metal stent in three...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Acute myocardial infarction (MI) necessitates timely intervention, often involving percutaneous coronary intervention (PCI) with stent implantation.
• Stent thrombosis, a rare but serious complication, can occur despite the use of drug-eluting stents (DES).
• This case presents a unique scenario of late stent thrombosis involving both bare-metal stents (BMS) and sirolimus-eluting stents (SES) in a young patient.

Purpose of the Study:

• To describe a case of acute myocardial infarction secondary to late stent thrombosis.
• To investigate the clinical course and angiographic findings of spontaneous thrombus resolution in multiple stented coronary arteries.
• To contribute to the understanding of stent thrombosis and its potential for spontaneous resolution.

Main Methods:

• A 36-year-old male patient diagnosed with acute inferior myocardial infarction underwent emergent coronary angiography (CAG) and subsequent percutaneous coronary intervention (PCI) with BMS and SES implantation.
• Elective PCI with SES implantation was performed for additional coronary lesions in the left anterior descending (LAD) and left circumflex (LCX) arteries.
• Follow-up CAG at 9 months showed no restenosis. Two years and 4 months later, the patient presented with acute anterior MI due to in-stent thrombosis in the LAD, with thrombotic lesions also noted in the BMS of the RCA and SES of the LCX.

Main Results:

• Emergent CAG revealed total thrombotic occlusion in the proximal in-stent LAD, as well as in-stent thrombotic lesions in the BMS of the RCA and SES of the LCX.
• The patient underwent intracoronary aspiration thrombectomy and balloon angioplasty for the LAD lesion, with no intervention performed on the RCA and LCX lesions.
• Follow-up CAG 17 days after the intervention demonstrated complete resolution of thrombi in the LAD, LCX, and RCA.

Conclusions:

• Late stent thrombosis can occur in patients with multiple coronary stents, including BMS and SES.
• Spontaneous resolution of coronary thrombi, even in stented segments, is possible.
• This case underscores the complex pathophysiology of stent thrombosis and highlights the potential for favorable outcomes with conservative management in select circumstances.