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Published on: November 19, 2020
A case of coronary artery disease with antiphospholipid syndrome that showed repeated stent thrombosis
Takahiro Mito1, Shin-Ichiro Miura1, Kohei Takada1
1Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Insights
Recurrent stent thrombosis after percutaneous coronary intervention (PCI) may indicate primary antiphospholipid syndrome. Coronary artery bypass graft surgery is an alternative if PCI is not feasible.
Area of Science:
- Cardiology
- Vascular Medicine
- Immunology
Background:
- Acute coronary syndrome requires prompt intervention.
- Percutaneous coronary intervention (PCI) is a common treatment for coronary artery occlusion.
- Stent thrombosis and restenosis are potential complications following PCI.
Purpose of the Study:
- To investigate the potential cause of recurrent stent thrombosis in a patient with acute coronary syndrome.
- To highlight the diagnostic considerations for unexplained stent thrombosis.
- To discuss alternative treatment strategies when PCI fails.
Main Methods:
- Case report of a 55-year-old male patient.
- Coronary angiography to diagnose coronary artery occlusion.
- Percutaneous coronary intervention (PCI) for recanalization.
- Monitoring for complications such as stent thrombosis and restenosis.
Main Results:
- Successful recanalization of the left anterior descending coronary artery via PCI.
- Development of subacute stent thrombosis and restenosis.
- Recurrent thrombosis despite repeat PCI procedures.
- Consideration of primary antiphospholipid syndrome as an underlying cause.
Conclusions:
- Primary antiphospholipid syndrome should be suspected in cases of recurrent stent thrombosis.
- Coronary artery bypass graft (CABG) surgery may be a necessary alternative when PCI is repeatedly unsuccessful.
- Multidisciplinary management is crucial for complex cardiovascular cases.
Abstract:
A 55-year-old man with severe chest pain was hospitalized for acute coronary syndrome. Coronary angiography revealed total occlusion of his left anterior descending coronary artery, which was successfully recanalized by percutaneous coronary intervention (PCI). However, the patient subsequently experienced subacute stent thrombosis, restenosis in the stent, and frequent thrombosis in PCI toward restenosis. Primary antiphospholipid syndrome should be considered as a possible cause of repeated stent thrombosis, and, if salvage by PCI is impossible, salvage by coronary artery bypass graft should be considered.
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