Acute and subacute stent thrombosis in a patient with clopidogrel resistance: a case report.
Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.
Kim
Sung Soo
SS
The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea.
Jeong
Myung Ho
MH
Kim
Hyun-Kuk
HK
Bae
Soo Young
SY
Ryu
Kyoung Ho
KH
Cho
Kyung Hun
KH
Kim
Min Chul
MC
Park
Keun Ho
KH
Sim
Doo Sun
DS
Hong
Young Joon
YJ
Kim
Ju Han
JH
Ahn
Youngkeun
Y
Kang
Jung Chaee
JC