Complicating a very late stent thrombosis

• Main Authors: Pablo Salinas, Pedro Martínez-Losas, Hernán Mejía-Rentería, Luis Nombela-Franco, Iván J. Núñez-Gil, Antonio Fernández-Ortiz
• Format: Article
• Language: English
• Published: Permanyer 2021-05-01
• Series: REC: Interventional Cardiology (English Ed.)
• Online Access: https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=398

A 61-year-old male with a drug-eluting stent (DES) implanted 5 years ago (no further information) was admitted with anterior myocardial infarction. The emergent coronary angiography performed revealed the presence of very late stent thrombosis (VLST) (figure 1A, stent in green arrows, video 1 of the supplementary data). A Sion wire (Asahi Intecc) was easily advanced, but thromboaspiration catheter failed to cross. A 2.5 mm compliant balloon that crossed easily was used to restore the flow (figure 1B, video 2 of the supplementary data). Intravascular ultrasound (IVUS) revealed the presence of proximal stent deformation (partial crush) (figure 2A, red arrows indicating crushed struts); and significant undersizing or underexpansion (average stent diameter of 2.75 mm, green arrows and 4.5 mm reference diameter, blue line, figure 2B). Stent enhancement confirmed the IVUS findings. Given the deformation of the stent and the mismatch between the stent and the vessel size, we dilated with a 4 mm non-compliant balloon (20 atm) and implanted a new 4 mm x 28 mm DES with excellent final results (figure 3, video 3 of the supplementary data). Presence of possible distal myocardial bridging.