Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Very Late Stent Thrombosis due to Neointimal Rupture After Paclitaxel-Eluting Stent Implantation

  • Kee, Won-Ju (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Jeong, Myung-Ho (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Jang, Soo-Young (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Lee, Min-Goo (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Park, Keun-Ho (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Sim, Doo-Sun (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Hong, Young-Joon (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Kim, Ju-Han (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Ahn, Young-Keun (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital) ;
  • Kang, Jung-Chaee (The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital)
  • Published : 2011.12.30
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Abstract

We report our experience of very late stent thrombosis (VLST) in a young male patient who underwent implantation of two paclitaxel-eluting stents (PES) six years ago. The patient was compliant with standard dual antiplatelet therapy, but he presented with acute myocardial infarction which was associated with VLST. Intravascular ultrasound showed neointimal rupture with thrombus within the PES implanted in the right coronary artery. The lesion was successfully treated with balloon angioplasty without complications, however he was found to be hyporesponsive to clopidogrel when tested for adenosine diphosphate-induced platelet aggregation. The patient was discharged after uneventful recovery with triple anti-platelet therapy using aspirin, clopidogrel and cilostazol. To the best of our knowledge, a time interval of 2,223 days is the longest reported time interval between PES deployment and VLST occurrence. VLST may indeed occur in clinically stable patients, as multiple factors can influence the pathological mechanisms of VLST.

Keywords

References

  1. Farb A, Heller PF, Shroff S, et al. Pathological analysis of local delivery of paclitaxel via a polymer-coated stent. Circulation 2001;104:473-9. https://doi.org/10.1161/hc3001.092037
  2. Rogers C, Parikh S, Seifert P, Edelman ER. Endogenous cell seeding: remnant endothelium after stenting enhances vascular repair. Circulation 1996;94:2909-14. https://doi.org/10.1161/01.CIR.94.11.2909
  3. Jensen LO, Maeng M, Kaltoft A, et al. Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions. J Am Coll Cardiol 2007;50:463-70. https://doi.org/10.1016/j.jacc.2007.06.002
  4. Seol SH, Kim DI, Han YC, et al. Multiple sequential complications after sirolimus-eluting stent implantation: very late stent thrombosis, stent fracture, in-stent restenosis, and peri-stent aneurysm. Korean Circ J 2009;39:439-42. https://doi.org/10.4070/kcj.2009.39.10.439
  5. Kim SS, Jeong MH, Sim DS, et al. Very late thrombosis of a drug-eluting stent after discontinuation of dual antiplatelet therapy in a patient treated with both drug-eluting and bare-metal stents. Korean Circ J 2009;39:205-8. https://doi.org/10.4070/kcj.2009.39.5.205
  6. Ahn YS, Cho JH, Kim DH, et al. A fatal case of simultaneous, very late thrombosis involving three drug-eluting stents in three coronary arteries. Korean Circ J 2008;38:564-9. https://doi.org/10.4070/kcj.2008.38.10.564
  7. Nam CW, Kim KB, Chung IS. Very late stent thrombosis related to fracture of a sirolimus-eluting stent. Korean Circ J 2007;37:385-7. https://doi.org/10.4070/kcj.2007.37.8.385
  8. Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 2007;356:1020-9. https://doi.org/10.1056/NEJMoa067731
  9. Ellis SG, Colombo A, Grube E, et al. Incidence, timing, and correlates of stent thrombosis with the polymeric paclitaxel drug-eluting stent: a TAXUS II, IV, V, and VI meta-analysis of 3,445 patients followed for up to 3 years. J Am Coll Cardiol 2007;49:1043-51. https://doi.org/10.1016/j.jacc.2007.01.015
  10. Wenaweser P, Daemen J, Zwahlen M, et al. Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol 2008;52:1134-40. https://doi.org/10.1016/j.jacc.2008.07.006
  11. Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006;48:193-202. https://doi.org/10.1016/j.jacc.2006.03.042
  12. Yokoyama S, Takano M, Sakai S, et al. Difference in neointimal proliferation between ruptured and non-ruptured segments after bare metal stent implantation. Int Heart J 2010;51:7-12. https://doi.org/10.1536/ihj.51.7
  13. Higo T, Ueda Y, Oyabu J, et al. Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study. JACC Cardiovascular Imaging 2009;2:616-24. https://doi.org/10.1016/j.jcmg.2008.12.026
  14. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005;293:2126-30. https://doi.org/10.1001/jama.293.17.2126
  15. Muller I, Besta F, Schulz C, Massberg S, Schonig A, Gawaz M. Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement. Thromb Haemost 2003;89:783-7.
  16. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. Identification of low responders to a 300 mg clopidogrel loading dose in patients undergoing coronary stenting. Thromb Res 2005;115:101-8. https://doi.org/10.1016/j.thromres.2004.07.007