A case of very late stent thrombosis after sirolimus-eluting stent implantation in a patient with provoked severe coronary spasm

Shigenori Ito, Masahiko Inomata

Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan.

DOI: 10.4236/wjcd.2013.34A002                

Abstract

A 73-year-old male patient suffered from very late stent thrombosis occurred 6 years after sirolimuseluting stent (SES) implantation in the ostial and proximal left anterior descending coronary artery (LAD). He presented emergently with cardiogenic shock and emergent coronary angiography showed thombus in the ostial stent and in the ostial left circumflex artery. Optical coherence tomography found delayed healing on the ostial stent. Acetylcholine provocation test had also shown severe provoked coronary spasm in all coronary arteries 28 months after SES implantation which suggested the association of severe coronary endothelial dysfunction as a potential mechanism of very late stent thrombosis.

Keywords

Stent Thrombosis; Drug-Eluting Stent; Coronary Spasm; Coronary Endothelial Dysfunction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Joner, M., Finn, A.V., Farb, A., et al. (2006) Pathology of drug-eluting stents in humans: Delayed healing and late thrombotic risk. Journal of the American College of Cardiology, 48, 193-202. doi:10.1016/j.jacc.2006.03.042
[2]	Nakazawa, G., Finn, A.V., Joner, M., et al. (2008) Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: An autopsy study. Circulation, 118, 1138-1145. doi:10.1161/CIRCULATIONAHA.107.762047
[3]	Guagliumi, G., Sirbu, V., Musumeci, G., et al. (2012) Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: Findings from optical coherence tomography and intravascular ultrasound imaging. JACC: Cardiovascular Interventions, 5, 12-20. doi:10.1016/j.jcin.2011.09.018
[4]	Miyazaki, S., Hiasa, Y., Takahashi, T., et al. (2012) In vivo optical coherence tomography of very late drug-eluting stent thrombosis compared with late in-stent restenosis. Circulation Journal, 76, 390-398. doi:10.1253/circj.CJ-11-0961
[5]	Cook, S., Wenaweser, P., Togni, M., et al. (2007) Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation, 115, 24262434. doi:10.1161/CIRCULATIONAHA.106.658237
[6]	Breet, N.J., Van Werkum, J.W., Bouman, H.J., et al. (2011) High on-treatment platelet reactivity to both aspirin and clopidogrel is associated with the highest risk of adverse events following percutaneous coronary intervention. Heart, 97, 983-990. doi:10.1136/hrt.2010.220491
[7]	Nakazawa, G., Otsuka, F., Nakano, M., et al. (2011) The pathology of neoatherosclerosis in human coronary implants. Journal of the American College of Cardiology, 57, 1314-1322. doi:10.1016/j.jacc.2011.01.011
[8]	Togni, M., Raber, L., Cocchia, R., et al. (2007) Local vascular dysfunction after coronary paclitaxel-eluting stent implantaion. International Journal of Cardiology, 120, 212-220. doi:10.1016/j.ijcard.2006.09.021
[9]	Hamilos, M., Sarma, J., Ostojic, M., et al. (2008) Interference of drug-eluting stents with endothelium-dependent coronary vasomotion: Evidence for device-specific responses. Circulation: Cardiovascular Interventions, 1, 193-200. doi:10.1161/CIRCINTERVENTIONS.108.797928
[10]	Hamilos, M.I., Ostojic, M., Beleslin, B., et al. (2008) On behalf of the NOBORI CORE investigators. Differential effects of drug-eluting stents on local endothelium-dependent coronary vasomotion. Journal of the American College of Cardiology, 51, 2123-2129. doi:10.1016/j.jacc.2007.12.059
[11]	Jabs, A., Gobel, S., Wenzel, P., et al. (2008) Sirolimusinduced vasomotor dysfunction increased mitochondrial and nicotinamide adenosine dinucleotide phosphate oxidase-dependent superoxide production and decreased vascular nitric oxide formation. Journal of the American College of Cardiology, 51, 2130-2138. doi:10.1016/j.jacc.2008.01.058
[12]	Kim, J.W., Suh, S.Y., Choi, C.U., et al. (2008) Six-month comparison of coronary endothelial dysfunction associated with sirolimus-eluting stent versus paclitaxel-eluting stent. JACC: Cardiovascular Interventions, 1, 65-71. doi:10.1016/j.jcin.2007.11.002
[13]	Muhlestein, J.B. (2008) Endothelial dysfunction associated with drug-eluting stent. Journal of the American College of Cardiology, 51, 2139-2140. doi:10.1016/j.jacc.2008.02.057
[14]	Ito, S., Nakasuka, K., Morimoto, K., et al. (2011) Angiographic and clinical characteristics of patients with acetylcholine-induced coronary vasospasm on follow-up coronary angiography following drug-eluting stent implantation. Journal of Invasive Cardiology, 23, 57-64.
[15]	Minami, Y., Kaneda, H., Inoue, M., et al. (2012) Endothelial dysfunction following drug-eluting stent implantation: A systematic review of the literature. International Journal of Cardiology, 165, 222-228.
[16]	Egashira, K., Araki, H., Takeshita, A., Nakamura, M. (1989) Silent myocardial ischemia in patients with variant angina. Japanese Circulation Journal, 53, 1452-1457. doi:10.1253/jcj.53.1452
[17]	Beltrame, J.F., Sasayama, S. and Maseri, A. (1999) Racial heterogeneity in coronary artery vasomotor reactivity: Differences between japanese and caucasian patients. Journal of the American College of Cardiology, 33, 1442-1452. doi:10.1016/S0735-1097(99)00073-X
[18]	Pristipino, C., Beltrame, J.F., Finocchiaro, M.L., et al. (2000) Major racial differences in coronary constrictor response between japanese and caucasians with recent myocardial infarction. Circulation, 101, 1102-1108. doi:10.1161/01.CIR.101.10.1102