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Late Stent Thrombosis at the Proximal Segment of Sirolimus-Eluting Stent
- Operator: Myeong-Ki Hong, MD, Bong-Ki Lee, MD, Korea

A 65-year old female patient was admitted with intermittent resting chest pain for 1 week. Her risk factors were hypertension and diabetes mellitus. The patient had been treated with a 3.5 x 30mm Terumo stent at the middle segment of the left anterior descending artery (LAD) 15 months ago. Eight months after stent implantation, the patient had been readmitted with recurrent chest pain, and underwent stent re-implantation with a 3.5 x 33mm Cypher stent at the in-stent restenosis site of the LAD (Figure 1, pre-intervention; Figure 2, stent implantation; Figure 3, post-intervention). Then, she was discharged and had been on continuous dual antiplatelet medication with aspirin and clopidogrel. Seven months after the second stenting, she had been suffered recurrent chest pain for 1 week and re-admitted for follow-up coronary angiography. Cardiac enzymes, such as CK-MB and Troponin I, and echocardiogram were normal. The coronary angiogram showed total occlusion of proximal LAD with intraluminal thrombus extended from the proximal segment of Cypher stent (Figure 4). She was treated with consecutive stenting with two 3.5 x 23mm Cypher stents at the proximal LAD occlusion site (Figure 5, Figure 6). The coronary angiography after the stenting showed restoration of normal coronary blood flow (Figure 7).
Bon-Kwon Koo2004-03-12
박성훈2004-03-13
There is some limitations for using DES. In this era, I think classical, conventional PCI (using non-drug eluting stent) was one of the choice for this case. Once more time, I will use non-DES for this patient because the lumen of LAD was over 3.5mm.
gordonching2004-03-21
Marcelo Ribeiro2004-04-04
Wasn't the angiographic picture of the acute event more suggestive of proximal border restenosis with superimposed thrombosis?
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