In the
drug-eluting stent era,
stent thrombosis is uncommon but still a life-threatening complication after
percutaneous coronary intervention. There are several types of risk factors associated with
stent thrombosis, which could work synergistically to produce
thrombus. We report the case of subacute
stent thrombosis. A 66-year-old male was hospitalized due to
ST-segment elevation myocardial infarction and received emergency
percutaneous coronary intervention to the obtuse marginal branch and the posterolateral artery. Five days later, he complained of
chest pain. Emergency coronary angiography was performed and revealed
stent thromboses in both the obtuse marginal branch and the posterolateral artery. Remarkably, in this case,
stent thromboses occurred in the obtuse marginal branch and the posterolateral artery simultaneously. Finally, we overcame this situation by stenting to the main branch of left circumflex artery. We speculated the precise mechanism of simultaneously occurring two subacute
stent thromboses through multiple intracoronary imaging modalities. In this case, we hypothesized that the combination of the protrusion of obtuse marginal branch
stent to the main branch of left circumflex artery, blood flow turbulence due to the
ulcer, and relatively high thrombogenicity of
acute coronary syndrome lesion synergistically generated the
thrombus. <Learning objective:
Stent thrombosis following
percutaneous coronary intervention is known as a life-threatening complication. To deal with this fatal complication appropriately, we should know the etiology of
stent thrombosis. In this case, we revealed the effect of synergistic mechanism by enhanced thrombogenicity, malapposed struts, and blood flow turbulence by using multiple imaging modalities. Thus, we could decide to deploy the
stent to the
ulcer-like lesion of the main branch of the left circumflex artery.>.