Optical Coherence Tomography Findings in Early Stent Thrombosis by Heparin-Induced Thrombocytopenia.
A 62-year-old man with a family history of coronary artery disease and a history of smoking, diabetes and dyslipidemia was admitted to our hospital with chest pain from acute myocardial infarction. Emergent coronary angiography was performed with intervention to a mid-right coronary occlusion with drug-eluting stent implantation. Optical coherence tomography (OCT) visualized well-apposed stent struts and no remarkable tissue protrusion, stent underexpansion, malapposition, edge dissection, and hematoma. Immediately after OCT imaging, a coronary angiogram showed a filling defect surrounded by contrast medium at the site of the stented lesion. OCT imaging was performed again and a low backscattering protrusion suggestive of white thrombus in the coronary lumen was clearly visualized in OCT imaging. We performed thrombus aspiration immediately after OCT imaging. Aspirated thrombi were off-white in color. We made a diagnosis of early-onset heparin-induced-thrombocytopenia (HIT) due to thrombus formation within the stent and positive HIT antibodies. OCT in the acute phase of stent thrombosis allowed us to promptly identify the main causative mechanisms of early stent thrombosis.
Department of Cardiology, Kawasaki Medical School.
Hiroshi
H
Okamoto
Teruyoshi
T
Kume
Kenzo
K
Fukuhara
Yusuke
Y
Kobayashi
Ai
A
Kawamura
Yutaka
Y
Goryo
Terumasa
T
Koyama
Tomoko
T
Tamada
Ryotaro
R
Yamada
Koichiro
K
Imai
Yoji
Y
Neishi
Shiro
S
Uemura
D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D054855:Drug-Eluting Stents; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis; D041623:Tomography, Optical Coherence
D005343:Fibrinolytic Agents; D006493:Heparin