A case of very late stent thrombosis on the protruded struts at the left main coronary bifurcation
| Autor: | Kyohei Meno, Yoshinobu Murasato, Katsuhiko Takenaka, Kodai Shibao |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty business.industry Hemodynamics 030204 cardiovascular system & hematology medicine.disease Chest pain Article 03 medical and health sciences Ostium surgical procedures operative 0302 clinical medicine Internal medicine cardiovascular system Cardiology Medicine cardiovascular diseases 030212 general & internal medicine Myocardial infarction Stent thrombosis medicine.symptom Thrombus Cardiology and Cardiovascular Medicine business Coronary bifurcation |
| Zdroj: | J Cardiol Cases |
| ISSN: | 1878-5409 |
| Popis: | A previous autopsy study has revealed that malapposed or protruded struts in the coronary bifurcation were a risk factor for very late stent thrombosis (VLST); however, a live clinical case has not yet been reported due to difficulty in observation at the VLST site. In this case, a 56-year-old male patient underwent a zotarolimus-eluting stent implantation in the proximal left anterior descending artery for acute myocardial infarction 3 years previously and had been treated with dual antiplatelet therapy. The patient experienced chest pain and suddenly collapsed due to acute coronary syndrome caused by a huge thrombus in the left main coronary bifurcation. After insertion of the intra-aortic balloon pump, kissing balloon inflation improved coronary flow and hemodynamics. Two weeks later, a 3-dimensional optical frequency domain imaging (3-D OFDI) revealed uncovered protruded struts on the ostium of the left circumflex artery (LCX). We removed the protruded struts using a double lumen catheter, for which the second wire was advanced to more distal cell along with the first wire located in the same LCX branch. 3-D OFDI clearly demonstrated that uncovered protruded struts at the LCX ostium were the cause of VLST and navigated optimal wiring with a double lumen catheter. Learning objective: Existence of protruded struts at the coronary bifurcated branch ostium is a risk factor for very late stent thrombosis. Three-dimensional optical frequency domain imaging clearly demonstrates the protruded strut configuration at the side branch of ostium and facilitates optimal guide wire re-crossing for kissing balloon inflation. Usage of double lumen catheter increases the possibility of optimal side branch wiring. |
| Databáze: | OpenAIRE |
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