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Optical Coherence Tomography Findings in Early Stent Thrombosis by Heparin-Induced Thrombocytopenia

Hiroshi Okamoto1, Teruyoshi Kume, Kenzo Fukuhara

  • 1Department of Cardiology, Kawasaki Medical School.

International Heart Journal
|November 8, 2016
PubMed

Insights

Early stent thrombosis was diagnosed using optical coherence tomography (OCT) in a patient with acute myocardial infarction. OCT imaging identified white thrombus, leading to a diagnosis of heparin-induced thrombocytopenia (HIT).

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • A 62-year-old male with risk factors for coronary artery disease presented with acute myocardial infarction.
  • The patient underwent emergent coronary angiography and drug-eluting stent implantation for a mid-right coronary occlusion.

Observation:

  • Initial optical coherence tomography (OCT) after stenting showed no immediate complications.
  • A subsequent coronary angiogram revealed a filling defect, prompting repeat OCT imaging.
  • Repeat OCT identified a low backscattering protrusion, indicative of white thrombus within the stent.

Findings:

  • Thrombus aspiration confirmed the presence of white thrombus.
  • The patient was diagnosed with early-onset heparin-induced thrombocytopenia (HIT) based on thrombus formation and positive HIT antibodies.
  • OCT imaging in the acute phase was crucial for identifying the cause of early stent thrombosis.

Implications:

  • Optical coherence tomography is a valuable tool for diagnosing early stent thrombosis in acute myocardial infarction.
  • Prompt identification of stent thrombosis mechanisms, such as HIT, can guide immediate therapeutic interventions.
  • This case highlights the utility of OCT in elucidating the pathophysiology of acute stent thrombosis.

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