scholarly journals Pathological assessment of very late bare metal stent thrombosis in the left main coronary artery: a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Haruhito Yuki ◽  
Toru Naganuma ◽  
Gaku Nakazawa ◽  
Sunao Nakamura
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Left Main Coronary Artery ◽  
Bare Metal Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Left Main ◽  
Very Late Stent Thrombosis ◽  
Pathological Assessment

Abstract Background Late catch-up phenomenon following stent implantation is a well-known complication. However, no report has evaluated thrombosis after 9 years with multi-modality and pathological evaluation. Case summary A 71-year-old man with stable angina underwent elective percutaneous intervention of the left main coronary artery with implantation of a bare metal stent (BMS) 9 years ago. At the 9-year follow-up, coronary computed tomography (CCT) and coronary angiography (CAG) findings revealed a thrombus-like structure in the BMS slightly protruding into the sinus of Valsalva. Therefore, the previously prescribed double-antiplatelet therapy was replaced with an anticoagulant and clopidogrel, and a potent statin treatment was initiated. After the changes in drug treatment, follow-up examinations with CCT at 1 and 3 months suggested a decrease in the size of the thrombus; however, it appeared to increase after 6 months. Subsequently, the patient underwent surgical intervention. Pathological assessment of the explanted stent showed a proteoglycan-dominated extracellular matrix with few smooth muscle cells suggesting an organized thrombus. Discussion It should be emphasized that multiple factors might be responsible for very late stent thrombosis, such as peri-stent strut chronic inflammation involving proteoglycans, stent protrusion, and poorly controlled type 2 diabetes mellitus, possibly further inducing inflammatory cells.

scholarly journals Seven-Year Clinical Outcomes of Unprotected Left Main Coronary Artery Stenting With Drug-Eluting Stent and Bare-Metal Stent

2013 ◽  
Vol 77 (10) ◽  
pp. 2497-2504 ◽  
Author(s):  
Shunsuke Kubo ◽  
Kazushige Kadota ◽  
Takenobu Shimada ◽  
Masatomo Ozaki ◽  
Tahei Ichinohe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Outcomes ◽  
Left Main Coronary Artery ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Left Main ◽  
Coronary Artery Stenting ◽  
Drug Eluting

scholarly journals Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention

2011 ◽  
Vol 139 (9-10) ◽  
pp. 669-672 ◽  
Author(s):  
Sonja Salinger-Martinovic ◽  
Sinisa Stojkovic ◽  
Milan Pavlovic ◽  
Zoran Perisic ◽  
Slobodan Obradovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Bare Metal Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Guiding Catheter

Introduction. Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication. Case Outline. We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion. Conclusion. Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.

Abstract 2566: Late and Very Late Stent Thrombosis following Elective Drug Eluting Stent Implantation in Unprotected Left Main Coronary Artery: a Multicentre Registry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alaide Chieffo ◽  
Young H Kim ◽  
Emanuele Meliga ◽  
Seung J Park ◽  
Marco Valgimigli ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Left Main Coronary Artery ◽  
Drug Eluting Stent ◽  
Late Stent Thrombosis ◽  
Left Main ◽  
Very Late Stent Thrombosis ◽  
Drug Eluting

The long-term safety of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. Some concerns have been recently raised regarding the risk of late and very late stent thrombosis (ST). Methods: All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and June 2006 were included in this multicentre registry. Stent thromboses were defined according to Academic Research Consortium (ARC) definitions. Results Five-hundred and thirty-four consecutive patients were analyzed: 357 patients were treated with SES, 168 with PES and 9 with both of them. One-hundred and thirty-eight (25.8%) patients were diabetics, 171 (32.0%) unstable angina, mean age 62.4 ± 11.4 years, EF 54.1 ± 11.2 %. Distal location occurred in 417 (78.0%) of the patients. Fifty-seven (10.6%) patients had a peri-procedural myocardial infarction (defined as CK-MB elevation ≥3 ULN). At 1044 ± 361 day clinical follow-up, 32 (5.9%) patients died: 23 (4.3%) were adjudicated as cardiac according to ARC definition. One patient had an acute ST (with cardiogenic shock treated with CABG), 1 a sub-acute ST (occlusion of circumflex artery treated with PCI) and 1 a late definite ST (in the left anterior descending artery with MI at 3 months while on antiplatelet therapy). None of the patients had a very late definite ST. In the Table are reported probable and possibile ST. Conclusions Treatment of LMCA stenosis with DES appears safe at long-term clinical follow-up with a 0.6% incidence of definite and probable ST at a median follow-up of almost 3 years. Table.

scholarly journals Comparison of Drug-Eluting Stent With Bare Metal Stent for Distal De Novo Unprotected Left Main Coronary Artery Stenosis

2011 ◽  
Vol 75 (2) ◽  
pp. 290-298 ◽  
Author(s):  
Shu-Kai Hsueh ◽  
Chiung-Jen Wu ◽  
Hsiu-Yu Fang ◽  
Yuan-Kai Hsieh ◽  
Chih-Yuan Fang ◽  
...  
Keyword(s):  
Left Main Coronary Artery ◽  
De Novo ◽  
Coronary Artery Stenosis ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Left Main ◽  
Main Coronary Artery Stenosis ◽  
Drug Eluting
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