Multiple sequential complications after sirolimus-eluting stent implantation: very late stent thrombosis, stent fracture, in-stent restenosis, and peri-stent aneurysm.
A 55-year-old male patient presented with an acute myocardial infarction. A sirolimus-eluting stent (SES) was implanted in the proximal left anterior descending artery (LAD). Eight months later, there was a newly developed distal LAD lesion. An additional SES was implanted. Twenty-eight months after the index procedure of primary coronary intervention, the electrocardiogram showed ST elevation in the precordial leads and an emergency coronary angiogram showed diffuse stent thrombosis (ST) in the proximal LAD. Thirty-four months after the index procedure, coronary angiography showed a large peri-stent coronary aneurysm in the proximal LAD and focal in-stent restenosis (ISR) at the proximal edge of the distal LAD stent. On fluoroscopy, a fracture was noted in the middle part of the distal SES. A zotarolimus- eluting stent (ZES) was deployed and overlapped the restenosis and fracture sites. Forty months after the index procedure, there were no changes in the size of the aneurysm or in the other stent complications including the fracture and restenosis. At present, the patient has remained asymptomatic for eight months.
Seol
Sang-Hoon
SH
Department of Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
Kim
Doo-Il
DI
Han
Yang-Chun
YC
Kim
Ki-Hun
KH
Kim
Dong-Kie
DK
Kim
Young-Bok
YB
Kim
Ung
U
Yang
Tae-Hyun
TH
Kim
Dae-Kyeong
DK
Kim
Dong-Soo
DS