Late acute thrombosis after paclitaxel eluting stent implantation

Abstract

Late (more than six months) total occlusion after coronary stenting is a progressive phenomenon occurring in approximately 4% of patients, leading to acute myocardial infarction in less than 0.5%. The process must be related to severe and progressive intimal hyperplasia. In patients receiving coronary stenting with simultaneous brachytherapy, late total occlusion has been reported at a higher rate and to be related to stent thrombosis rather than intimal hyperplasia. Late total occlusion presenting with an acute clinical event seven months after the implantation of a paclitaxel drug eluting stent is reported. The occlusion developed soon after the interruption of ticlopidine treatment, suggesting that the event had a thrombotic genesis and that the risk is not confined to the first six month period.

Figure 1

(a) Baseline angiogram of the left coronary artery showing the occlusion of the left anterior descending artery in the mid-segment. (arrows). (b) Optimal immediate angiographic result after implantation of a paclitaxel eluting stent.

Figure 2

Six month angiographic follow up showing persistent optimal result in the stented segment (arrow) with no evidence of intimal hyperplasia.

Figure 3

(a) Left coronary angiography showing the late total occlusion in the stented segment (magnified in c). (b) Angiography of the right coronary artery with collateral filling of the left anterior descending coronary artery in the segment distal to the occlusion.