scholarly journals Very late stent thrombosis associated with COVID-19 infection: a case report and review of the literature

2021 ◽  
Author(s):  
Shekhar Kunal ◽  
Vijay Pathak ◽  
Keshav Pathak ◽  
Monika Mishra ◽  
Shashi Mohan Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Anterior Wall ◽  
Acute Onset ◽  
Drug Eluting Stent ◽  
Prior History ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Coronary Syndrome ◽  
Artery Disease

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.

scholarly journals Optical Coherence Tomographic Insights of Very Late Stent Thrombosis of a Second-Generation Drug-Eluting Stent: A case report

2021 ◽  
Author(s):  
Parminder Singh Otaal ◽  
Atit A Gawalkar ◽  
Ajay Shunmugarajan
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Second Generation ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Coronary Syndrome ◽  
First Case ◽  
Drug Eluting

Abstract Background Very-very late stent thrombosis (VVLST) occurring more than five years after implantation of drug-eluting stent (DES) is extremely rare, being restricted to few case reports. Mainly described with 1st generation stents, this life-threatening complication has not been described with later-generation stents. We describe the first case of VVLST occurring 3309 days (> 9 years) after implantation of 2nd generation DES Case summary A 62-year-old male presented with the acute coronary syndrome. He has a history of percutaneous coronary intervention (PCI) to the right coronary artery (RCA) using the three second-generation DES more than nine years ago. Coronary angiogram revealed in-stent restenosis (ISR) with doubtful angiographic thrombus. Optical Coherence Tomography (OCT) confirmed the diagnosis of stent thrombosis (STh) localized to the stent overlap zone with underlying ISR. Patient underwent OCT guided PCI with DES implantation and was discharged on dual antiplatelet therapy including ticagrelor. He is doing well on follow-up at six months. Discussion STh can occur in second-generation stents nearly a decade after implant. Stent overlap segment is more prone to neo-atheroma formation and vulnerable plaque leading to STh. In addition to confirming the diagnosis, OCT provides exciting insights into the underlying mechanism. This has implications for long-term antiplatelet therapy in patients implanted with multiple stents.

Abstract 5992: Comparison of 4 Years Efficacy and Durability of Sirolimus-Eluting Stent and Paclitaxel- Eluting Stent Deployment in Patients with Very Long Coronary Lesions: Multicenter Registry in Asia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sunao Nakamura ◽  
Hisao Ogawa ◽  
Jang-Ho Bae ◽  
Yeo Hans Cahyadi ◽  
Wasan Udayachalerm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Late Stent Thrombosis ◽  
Cardiac Events ◽  
Stent Deployment ◽  
Very Late Stent Thrombosis ◽  
Coronary Lesion ◽  
Coronary Lesions ◽  
Sirolimus Eluting Stent

Aim : The aim of this study is to compare the 4 years safety and durability of Sirolimus-eluting stent (SES) and Paclitaxel-eluting stent (PES) deployment on the outcome of patients with very long coronary lesions (VLL). Methods : A prospective analysis of 656 patients 730 lesions (male 70.4%, mean age 66.9 yrs) with very long coronary lesion (≥40mm) (368 SES and 288 PES) in five high volume Asian centers after successful stenting in VLL was performed. Lesion locations of VLL were LAD 48.2% (SES 50.2%, PES 45.7%), LCX 18.5%, RCA 33.3%. Complete clinical follow-up to 4 years is being analyzed for all patients. Results : The baseline clinical characteristics between 2 groups were similar. At 4 years overall cardiac events of SES (16.3%) were lower than PES (24.0%) (p=0.03). See table for clinical results. Conclusion : The use of SES and PES in patients with very long coronary lesion was safe and feasible with low acute complication and low incidence of restenosis. SES showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) at 4 years clinical follow-up. SAT (sub acute stent thrombosis), LAST (late stent thrombosis: ~1year), VLAST (very late stent thrombosis: 1year~ 4years) MACE (death, myocardial infarction, CABG and PCI).

scholarly journals Acute Coronary Syndrome after 17 Years of Bare Metal Stent Implantation: “Very” Very Late Stent Thrombosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Raghavendra Rao K ◽  
S. Reddy ◽  
J. R. Kashyap ◽  
K. Vikas ◽  
Hithesh Reddy ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Plaque Rupture ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Mortality And Morbidity ◽  
Coronary Syndrome

Very late stent thrombosis (VLST) is a catastrophic and life-threatening complication after percutaneous coronary intervention which presents as an acute coronary syndrome with significantly high mortality and morbidity. VLST is a rare entity with drug-eluting stents and even rarer with bare metal stents. The exact pathophysiologic mechanism of VLST after BMS implantation is not known although various mechanisms have been proposed. Recently, in-stent neoatherosclerosis with intimal plaque rupture has been proposed as a potential mechanism of VLST after BMS. We report a rare case of VLST occurring 17 years after BMS implantation with angiographic and intravascular imaging evidence which provides insight into the mechanisms of VLST.

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