Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Stent thrombosis is not very common but it is a serious complication of percutaneous coronary intervention (PCI). Here in, we present a case of 55 years old who presented with acute chest pain, was found to have non ST elevation myocardial infarction due to a thrombotic occlusion of prior drug eluting stent placed 20 years ago. A 55 years old male presented to the emergency department with one day history of mid-chest retrosternal pain that started while playing hockey, associated with nausea and diaphoresis. On initial evaluation, vital signs were stable, and patient was afebrile. Cardiac examination was normal with regular rate and rhythm with no evidence of murmur, gallop or rub. physical examination was unremarkable. Blood studies revealed leukocytosis with white count of 10.3. Comprehensive metabolic panel revealed creatinine of 1.60 along with normal liver function tests. Cardiac troponin was 0.04 and started trending up to reach 2.02. The initial EKG revealed normal sinus rhythm with no ST or T wave abnormalities. Patient continued to have chest pain during hospitalization, along with rising in troponin level, patient was taken urgently to the cath lab and he was found to have totally occluded LAD with TIMI flow 0. Patient was found to have thrombosis of the mid LAD stent which extended to the proximal LAD. Patient`s ejection fraction was around 30%. He underwent successful vascularization of the LAD with balloon angioplasty and manual thrombectomy with retrieval of thrombus. Coronary stent thrombosis is rare but it is associated with a very high risk of mortality or death [1]. It is classified as acute which occurs within 24 hours post stent placement, subacute which occurs within 1 to 30 days, late that occurs in 1 to 12 months and very late which occurs beyond one year [2] . Very late stent thrombosis is the rarest to happen as it occurs in 0.4-0.6% in patients who have sirolimus drug eluting stent [3] . The cause of stent thrombosis generally is either related to the patient, procedure or to the stent [4] . Whereas similar to our case, in very late stent thrombosis it is mainly attributed to malposition or fracture of the stent, de novo plaque rupture or abnormal re-endothelialization [5-8]. Multiple case reports were published in the past for in-stent thrombosis, where the longest to happen was 9.5 years after stent placement [9]. For our knowledge, our case is by far the longest reported interval to happen after 20 years of drug eluting stent placement. This occurrence of stent thrombosis after this long period of time will continue to question the time interval of how long patient should stay on dual antiplatelet therapy [11]. Where our patient was discharged on dual antiplatelet therapy for one year and then he continued to be on aspirin until his recent presentation.
Recommended Citation
Gaith H, Bangash N. Instent thrombosis 20 years after stent placement. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI