Recurrent subacute stent thrombosis after drug-eluting stent implantation: a case report

While drug-eluting stents (DESs) have revolutionized percutaneous coronary intervention (PCI), early stent-related complications remain challenging. We present a rare case of recurrent subacute stent thrombosis (ST) following DES implantation.

A 51-year-old female with acute inferior-posterior myocardial infarction underwent primary PCI with everolimus-eluting stent deployment in the left circumflex artery (LCX). Despite dual antiplatelet therapy, she developed recurrent LCX occlusion at 8 days (subacute ST confirmed by intravascular ultrasound) and 25 days post-PCI. Serial interventions included additional stenting and drug-coated balloon angioplasty. Elevated platelet counts and negative autoimmune marker results suggest potential inadequate platelet inhibition or hypersensitivity reactions.

This case highlights the diagnostic challenges in differentiating ST from restenosis, emphasizes the role of intravascular imaging, and underscores the need for personalized antiplatelet regimens. Hypersensitivity reactions to stent components and Kounis syndrome should be considered in refractory cases.