Acute Stent Thrombosis: Severe In-Stent Malapposition and Insufficient Platelet Inhibition as Partners in Crime!

Acute stent thrombosis is a rare event. When it occurs, procedure- and patient-related factors need to be assessed. First, our case showed that wiring was only successful with a chronic total occlusion-derived technique, indirectly demonstrating a stent-related problem. In fact, OCT showed a remarkable in-stent malapposition. Second, insufficient platelet inhibition was another important factor that contributed to acute stent thrombosis, since morphine negatively affected ticagrelor absorption and onset of action.