Acute and subacute stent thrombosis in a patient with clopidogrel resistance: a case report.

Abstract:

:Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.

journal_name

Korean Circ J

authors

Kim SS,Jeong MH,Kim HK,Bae SY,Ryu KH,Cho KH,Kim MC,Park KH,Sim DS,Hong YJ,Kim JH,Ahn Y,Kang JC

doi

10.4070/kcj.2009.39.10.434

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

434-8

issue

10

eissn

1738-5520

issn

1738-5555

journal_volume

39

pub_type

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