Not All That Blurs is Clot: An Unusual But Not Infrequent Cause of Acute Coronary Syndrome

J INVASIVE CARDIOL 2017;29(4):E53-E54.

Key words: crushed stent, complications, stent implantation, thrombus

A 73-year-old man with a history of triple-vessel coronary artery disease and three previous percutaneous coronary interventions (PCIs) with four stents implanted at another institution, with the last PCI 3 months earlier, was admitted for non-ST segment elevation acute myocardial infarction. Coronary angiography showed patency of previous implanted stents in the first marginal branch and left anterior descending (LAD) coronary arteries, but an image that suggested the presence of an intrastent thrombus in the mid-LAD segment was visualized (Video 1). Optical coherence tomography (OCT) study showed correct stent apposition and expansion of previous stents, but a circular image suggestive of a “non-expanded stent intrastent” was identified (Figures 1A-1C). The non-expanded stent was crushed and covered with a new bare-metal stent due to several reasons, including a recently diagnosed bladder carcinoma, the increasing risk of urinary bleeding, the need for surgical procedures in the near future, and the prothrombotic state due to cancer with the risk of acute thrombosis of a drug-eluting stent (Video 2). OCT post stent implantation confirmed complete apposition of the crushed stent to the artery wall (Figures 1D-1F). The patient was discharged on dual-antiplatelet therapy for 1 year. Clinical follow-up at 6 months remained uneventful. One of the most frequent causes of acute coronary syndromes in patients with previous PCI is stent thrombosis. Intracoronary loss of unexpanded stents is rather an infrequent but serious complication that can trigger an acute cardiovascular event. Its proper identification is challenging and the best treatment strategy remains unclear.¹

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Reference

1.     Rivero F, Cuesta J, Benedicto A, et al. Phantom stent thrombosis: intracoronary imaging insights. JACC Cardiovasc Interv. 2015;8:864-865.

From the Hemodynamics & Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital Complex of Vigo, Vigo, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript submitted August 9, 2016, provisional acceptance given August 15, 2016, final version accepted September 14, 2016.

Address for correspondence: Etelberto Hernández Hernández, MD, Hemodynamics & Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital Complex of Vigo, Estrada Clara Campoamor, 341 Vigo, Pontevedra, Spain, 36312. Email: drhdz2@gmail.com