[Late stent thrombosis after intracoronary brachytherapy. A case report and review of the literature].
Intracoronary irradiation is currently the most promising approach to reduce restenosis after percutaneous transluminal coronary angioplasty. Meanwhile numerous data are available concerning efficacy and safety of this novel method. These data confirm the results of preclinical studies that reported a dramatic reduction of neo-intima proliferation and negative remodeling. However, the number of reports on an elevated incidence of late stent thrombosis (> 30 days post intervention) are increasing. It is commonly suggested that the delayed neo-intima formation within vascular stents is responsible for this new phenomenon. We report the case of a 48-year-old man who underwent coronary irradiation therapy after stent placement in a de-novo/restenotic lesion. Despite an explicit recommendation of a combined anti-aggregatory therapy consisting of ticlopidine and acetysalicylic acid for at least 6 months, ticlopidine was withdrawn after 4 weeks. Two weeks later, the patient was readmitted to an external hospital with an acute myocardial infarction and successfully treated with thrombolysis. The angiographic and intravascular control, which was conducted after another two weeks, showed absolutely no neointima formation within the implanted stent. Thus, a late thrombotic occlusion of the implanted stent appears most likely to be the cause underlying the myocardial infarction. This case underlines, together with other existing reports, the importance of a prolonged, combined anti-aggregatory therapy after stent placement and subsequent intracoronary irradiation.
Abteilung für Kardiologie Universitätsklinikum Essen Hufelandstr. 55 45122 Essen, Germany. christoph-naber@uni-essen.de
C K
CK
Naber
C A
CA
Kaiser
Y A
YA
Rahman
M
M
Haude
R
R
Erbel
D
D
Baumgart
D000787:Angina Pectoris / Q000209:etiology / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D001918:Brachytherapy; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D013326:Strontium Radioisotopes / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology*; D013988:Ticlopidine / Q000008:administration & dosage; D013997:Time Factors; D018084:Ultrasonography, Interventional; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D013326:Strontium Radioisotopes; D015021:Yttrium Radioisotopes; D013988:Ticlopidine; D001241:Aspirin