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Published on: December 20, 2024
First Case Report of Successful PCI with Thrombocytopenia Treated with Partial Splenic Artery Embolization
Toshiki Kaihara1, Yasuhiro Tanabe1, Takumi Higuma1
1Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
Insights
This case report details a novel approach for treating angina in a patient with severe thrombocytopenia. Partial splenic artery embolization successfully increased platelet count, enabling percutaneous coronary intervention with a drug-eluting stent.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hematology
Background:
- Thrombocytopenia poses significant challenges for dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation.
- Standard treatments like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) were not feasible for this patient due to low platelet counts.
Abstract:
Percutaneous coronary intervention (PCI) for patients with thrombocytopenia presents a difficult problem in that dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not suitable. This first case report describes our patient with angina pectoris and thrombocytopenia who we successfully treated with PCI after partial splenic artery embolization (PSE). A 70-year-old Japanese male was transferred to our hospital because of acute decompensated heart failure (ADHF). After medical treatment was administered, a coronary angiography (CAG) revealed three-vessel disease. He had severe thrombocytopenia (nadir of 27,000/μL) due to liver fibrosis. Coronary artery bypass grafting (CABG) and PCI were not feasible. PSE was performed, and splenic volume reduction was confirmed by computed tomography. As a result, the platelet count increased after PSE and we completed the PCI with a DES. Major bleeding complications and cardiac events did not occur under the DAPT. To the best of our knowledge, performing PSE before PCI for increasing a patient's platelet count for thrombocytopenia has never been reported. This method may be considered as one of the treatment strategies for angina patients with thrombocytopenia.
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