title: Stent thrombosis caused by metal allergy complicated by protein S deficiency and heparin-induced thrombocytopenia: a case report and review of the literature.
abstract: A 43-year-old woman recipient of a bare metal coronary stent during an acute anterior myocardial infarction was repeatedly hospitalized with recurrent stent thrombosis (ST) over the following 3 years. Emergent coronary angiography showed a thrombus in the in-stent segment of the proximal left anterior descending artery. We repeatedly aspirated the thrombus, which immediately reformed multiple times. The discontinuation of heparin and administration of thrombolytics and argatroban, followed by repeated balloon dilatations, ended the formation of new thrombi. The patient was found to be allergic to nickel, protein S deficient and carrier of heparin-induced thrombocytopenia antibody. We discuss this case in the context of a) literature pertaining to acute coronary syndromes in the young, and b) the detailed investigations needed to identify thrombotic risk factors. Steroids may be effective to prevent recurrent ST caused by stent allergy.
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan ; Department of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Funayama
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Beni
authors.initials: B
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakurai
authors.affiliation: Department of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Koko
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kashiwagi
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Sasa
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Gima
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Hideichi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hotta
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622 Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kikuchi
keywords: Heparin-induced thrombosis; Metal allergy; Protein S deficiency; Stent thrombosis