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Fatal stent thrombosis following successful treatment or coronary artery rupture in an octogenarian

T G Hennessy1, H A McCann, D D Sugrue

  • 1Department of Clinical Cardiology, Mater Misericordiae Hospital (University College), Dublin, Ireland.

Catheterization and Cardiovascular Diagnosis
|December 31, 1997
PubMed

Insights

A complex coronary artery stenting procedure led to artery rupture and cardiac tamponade. Despite interventions, stent thrombosis caused a fatal heart attack and cardiogenic shock.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Coronary artery disease (CAD) management frequently involves percutaneous coronary intervention (PCI) with stenting.
  • Calcified lesions in the left anterior descending (LAD) artery present unique challenges during stenting.
  • Coronary artery rupture is a rare but serious complication of PCI.

Observation:

  • A patient undergoing primary stenting for a calcified LAD stenosis experienced within-stent coronary artery rupture.
  • This rupture led to cardiac tamponade, necessitating pericardiocentesis.
  • Further stenting was performed to seal the perforation, but this was followed by stent thrombosis.

Findings:

  • The initial stenting procedure for calcified LAD stenosis was complicated by intra-stent rupture.
  • Subsequent stent placement to address the rupture ultimately resulted in stent thrombosis.
  • The patient developed an anterior myocardial infarction and fatal cardiogenic shock due to stent thrombosis.

Implications:

  • This case highlights the critical risks associated with stenting heavily calcified coronary arteries.
  • It underscores the potential for delayed complications like stent thrombosis even after initial procedural success.
  • Careful patient selection and advanced techniques may be crucial in managing complex calcified lesions to prevent catastrophic outcomes.

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