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Abstract
Late stent thrombosis is one of the most serious complications associated with morbidity and mortality after coronary drug-eluting stent implantation, and is mainly caused by the withdrawal of antiplatelet agents. We report our experience of late stent thrombosis simultaneously involving three different coronary arteries in a young male patient who was treated with three drug-eluting stents two years ago. The patient stopped taking antiplatelet agents for several days. The patient did not recover from cardiogenic shock, even after repeated ballooning with thrombus aspiration, intra-aortic balloon pumping, and temporary pacing during cardiopulmonary resuscitation.
References
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Fig. 1.
The first cardiac event, ECG obtained in the emergency room of another hospital showed Q and T wave inversions in the inferior leads. ECG: electrocardiogram.
Fig. 2.
During the first cardiac event. A and B: an emergency coronary angiography revealed total occlusion of the middle RCA, and critical stenosis in the proximal LAD and intermediate branch (A: LAO view, B: RAO cranial view). C and D: after coronary stenting, distal flow was restored to TIMI III in three coronary arteries (C: LAO view, D: AP cranial view). RCA: right coronary artery, LAD: left anterior descending artery, LAO: left anterior oblique, RAO: right anterior oblique, AP: anterioposterior, TIMI: thrombolysis in myocardial infarction.
Fig. 3.
The ECG taken in the emergency room during the second cardiac event showed ST elevation in the inferior leads. ECG: electrocardiogram.
Fig. 4.
During the second cardiac event (A and B) an emergency coronary angiography revealed patency in the previous stented sites ofthe middle right coronary artery, the proximal left anterior descending artery, and the intermediate branch with good distal flow (A: LAO view, B: AP cranial view). LAO: left anterior oblique, AP: anterioposterior.
Fig. 5.
The ECG obtained in the emergency room during the third cardiac event revealed complete AV block, a right bundle branch block, and ST elevation over the precordial and inferior leads. ECG: electrocardiogram, AV: atrioventricular.
Fig. 6.
During the third cardiac event. A and B: an emergent coronary angiography revealed simultaneous total occlusion of the middle RCA, proximal LAD, and intermediate branch, at the sites the three Taxus stents had been previously placed (A: LAO view, B: RAO cranial view). C and D: after placement of an intra-aortic balloon counterpulsation and temporary pacemaker, thrombus aspiration was performed by suction catheter. But, coronary flows at the occluded lesions of the proximal LAD and intermediate branch were not restored in spite of repeated ballooning and thrombus aspiration (C: LAO view, D: RAO cranial view). RCA: right coronary artery, LAD: left anterior descending artery, LAO: left anterior oblique, RAO: right anterior oblique.
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