Overcoming Technical Complexities in Late Coronary Stent Thrombosis: A Clinical Report

Complex bifurcation lesions often requiring a two-stent revascularization approach mean more metal, a higher risk of major adverse cardiovascular events, and added difficulties in the case of late complications, such as in-stent restenosis and stent thrombosis. In this article, we report a case of late stent thrombosis in a 56-year-old patient who had left main (LM) and left anterior descending (LAD) left circumflex arteries with T and small protrusion technique percutaneous intervention (PCI) one year before her admission with hemodynamic compromise and no access to urgent coronary artery bypass grafting (CABG). We discuss challenging and high-risk PCI with limited resources, and the result was satisfactory with a favorable outcome. Stent thrombosis, a critical and life-threatening complication of PCI, frequently manifests with ST-elevation myocardial infarction, carrying a high mortality risk. Known risk factors for stent thrombosis include stent underexpansion, inadequate lesion preparation, complex percutaneous procedures, and early discontinuation of dual antiplatelet therapy. The choice of revascularization strategy is crucial, particularly for patients with extensive coronary artery disease, where surgery allows for a more complete revascularization. Coronary angioplasty is a pleasing and less invasive technique, but it requires proper lesion preparation, optimization of stent deployment through intracoronary imaging, post-dilation, and, most importantly, adherence and proper use of antithrombotic treatment following guidelines and medical therapy, which remains the cornerstone of managing ischemic heart disease.