Late thrombosis in multivessel multistenting associated with anomalous origin of coronary artery

Introduction: We present a clinical case of acute myocardial infarction by late instent thrombotic occlusion in a patient with multivessel disease and multiple stents, for which we performed thromboaspiration and coronary angioplasty with unfavorable patient’s follow up. Methods: A 65 year old patient with diabetes mellitus and a prior history of anterior and inferior myocardial infarctions for which we practiced coronary angioplasty with drug-eluting stent on the left anterior descending artery (LAD), right coronary artery, circumflex artery (with separate origin within the right coronary sinus) and the LAD – for stent restenosis returned to the emergency room with a new myocardial infarction, after five months from the last intervention. On admission the patient was hypotensive, had a chest pain and the ECG was positive for anterior ST elevation myocardial infarction. The echocardiography showed akinesis of SIV and inferoposterior wall and hypokinesis of the anterolateral wall and apex with EF of 30%. Results: The patient underwent an emergency coronary angiography which revealed instent thrombotic acute occlusion of the LAD for which we performed thromboaspiration and balloon-only angioplasty. At the end of the procedure the patient presented ventricular fibrillation responsive to defibrillation. He was intubated, mechanically ventilated and the intra-aortic balloon counterpulsation was mounted. Shortly after intervention he developed bradycardia and asystole refractory to standard resuscitation. Conclusions: Despite two years of compliance in double antiplatelet therapy, the patient developed stent thrombosis five months after implantation of a new drug-eluting stent, for stent restenosis, which reaffirms the risk of this choice in solving the very disputed issue of drug-eluting stent restenosis.

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