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A unique case of ST-elevation myocardial infarction related to very late stent thrombosis.

ABSTRACT: A 67-year-old man was transferred to our hospital because of anterior ST elevation myocardial infarction (STEMI). He had a history of a sirolimus-eluting stent implantation from the left main to the left anterior descending coronary artery (LAD) 9 years before and had undergone laparoscopic prostatectomy 8 days before in the setting of discontinuation of dual antiplatelet therapy. Emergent coronary angiography showed total occlusion in the distal LAD that was successfully treated by aspiration alone. Optical coherence tomography (OCT) showed no vulnerable lesion from the occluded lesion to the proximal LAD. OCT demonstrated that the thrombus attached to floating struts at the left main bifurcation and non-apposed struts at the left coronary ostium partly protruding to aorta, while the other struts were covered and well-apposed. Based on OCT findings, this case of STEMI was thought to be caused by distal embolism of a thrombus that formed at the stent site before it evolved into total occlusion. <Learning objective: We demonstrated how optical coherence tomography can be essential in revealing the underlying pathology. The patient showed an unusual manifestation of ST-elevation myocardial infarction caused by distal embolism of a thrombus that formed at the sirolimus-eluting stent due to dual antiplatelet therapy discontinuation during perioperative period. Optical coherence tomography revealed very late stent thrombosis at the left coronary ostium and could elucidate the underlying mechanism.>.

SUBMITTER: Takahashi T

PROVIDER: S-EPMC6149559 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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A unique case of ST-elevation myocardial infarction related to very late stent thrombosis.

Takahashi Tatsunori T Okayama Hideki H Hiasa Go G Kazatani Yukio Y

Journal of cardiology cases 20171013 2

A 67-year-old man was transferred to our hospital because of anterior ST elevation myocardial infarction (STEMI). He had a history of a sirolimus-eluting stent implantation from the left main to the left anterior descending coronary artery (LAD) 9 years before and had undergone laparoscopic prostatectomy 8 days before in the setting of discontinuation of dual antiplatelet therapy. Emergent coronary angiography showed total occlusion in the distal LAD that was successfully treated by aspiration a ...[more]

PMID: 30279857

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Project description:AimsPatients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI.Methods and resultsABSORB-STEMI TROFI II was a multicentre, single-blind, non-inferiority, randomized controlled trial. Patients with STEMI who underwent primary percutaneous coronary intervention were randomly allocated 1:1 to treatment with the Absorb or EES. The primary endpoint was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition. Between 06 January 2014 and 21 September 2014, 191 patients (Absorb [n = 95] or EES [n = 96]; mean age 58.6 years old; 17.8% females) were enrolled at eight centres. At 6 months, HS was lower in the Absorb arm when compared with EES arm [1.74 (2.39) vs. 2.80 (4.44); difference (90% CI) -1.06 (-1.96, -0.16); Pnon-inferiority < 0.001]. Device-oriented composite endpoint was also comparably low between groups (1.1% Absorb vs. 0% EES). One case of definite subacute stent thrombosis occurred in the Absorb arm (1.1% vs. 0% EES; P = ns).ConclusionStenting of culprit lesions with Absorb in the setting of STEMI resulted in a nearly complete arterial healing which was comparable with that of metallic EES at 6 months. These findings provide the basis for further exploration in clinically oriented outcome trials.

Dataset Information

A unique case of ST-elevation myocardial infarction related to very late stent thrombosis.

Publications

A unique case of ST-elevation myocardial infarction related to very late stent thrombosis.

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