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A unique case of ST-elevation myocardial infarction related to very late stent thrombosis

Tatsunori Takahashi1, Hideki Okayama1, Go Hiasa1

  • 1Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.

Journal of Cardiology Cases
|October 4, 2018
PubMed

Insights

Discontinuation of dual antiplatelet therapy after sirolimus-eluting stent implantation led to ST-elevation myocardial infarction (STEMI). Optical coherence tomography revealed thrombus formation and distal embolism as the cause.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • A 67-year-old man presented with ST-elevation myocardial infarction (STEMI).
  • He had a history of sirolimus-eluting stent implantation in the left main and left anterior descending coronary artery (LAD) 9 years prior.
  • Dual antiplatelet therapy was discontinued 8 days before presentation due to laparoscopic prostatectomy.

Observation:

  • Coronary angiography revealed total occlusion of the distal LAD, treated successfully with aspiration.
  • Optical coherence tomography (OCT) identified thrombus attached to floating struts at the left main bifurcation and non-apposed struts at the left coronary ostium.
  • No vulnerable lesions were observed from the occluded site to the proximal LAD.

Findings:

  • The STEMI was attributed to distal embolism of a thrombus that formed at the sirolimus-eluting stent.
  • Very late stent thrombosis at the left coronary ostium was identified as the underlying pathology.
  • OCT imaging was crucial in elucidating the mechanism of STEMI in this case.

Implications:

  • This case highlights an unusual cause of STEMI related to dual antiplatelet therapy discontinuation and very late stent thrombosis.
  • Optical coherence tomography is essential for diagnosing complex stent-related complications and guiding treatment.
  • Understanding perioperative management of antiplatelet therapy in patients with coronary stents is critical to prevent adverse cardiovascular events.

Keywords:
Drug-eluting stentDual antiplatelet therapyOptical coherence tomography

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