title: Very late stent thrombosis occurring simultaneously in sirolimus-eluting stents and bare-metal stent in three different coronary vessels.
abstract: A 36-year-old male was diagnosed with acute inferior myocardial infarction (MI). Emergent coronary angiography (CAG) revealed an occlusive lesion in the distal segment of the right coronary artery (RCA). The proximal and distal sites of the lesion were treated with a bare-metal stent (BMS) and a sirolimus-eluting stent (SES), respectively. Nine days later, he underwent elective percutaneous coronary intervention (PCI). Two SESs were implanted for the stenotic lesion in the left anterior descending artery (LAD), in addition to one SES for the mid-stenotic lesion in the left circumflex artery (LCX). Nine months after PCI, follow-up CAG revealed no restenosis at any stent-implanted site. Two years and 4 months after PCI, he was admitted to our hospital because of acute anterior MI. Emergent CAG revealed total thrombotic occlusion in the in-stent proximal site of LAD. Moreover, thrombotic lesions were also observed in in-stent sites: in both BMS of RCA and SES of LCX. He underwent intracoronary aspiration thrombectomy and plain old balloon angioplasty for LAD using intra-aortic balloon pumping. PCI for the thrombotic lesions in RCA and LCX was not performed. Seventeen days after the stent thrombosis, CAG revealed the complete disappearance of thrombi in LAD, LCX, and RCA.
authors.affiliation: Department of Cardiology, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Sizuoka, 418-0076, Japan, kawaguti@crocus.ocn.ne.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Junpei
authors.initials: J
authors.lastname: Katayama
authors.forename: Azumi
authors.initials: A
authors.lastname: Kumazawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Wakahara