- Relevant clinical history and physical
exam:
A 44-year old male with unstable angina was referred to our hospital on
June 1, 2005.
proximal segment of the left anterior descending coronary artery (LAD)
95% stenosis, a distal segment of LAD 50%stenosis, a middle segment of
the left circumflex artery (LCX) 30-40% stenosis.
A 3.0×28mm sirolimus-eluting stent was deployed in proximal segment
of LAD using 18 atmospheres. A post-intervention coronary angiogram revealed
excellent . Clopidogrel was discontinued 9 months after stenting, but
aspirin, simvastatin, and ß-blocker were continued.
- Relevant test results prior to catheterization:
On May 24,2007, repeated angiography showed the SES in LAD was irregular.
(Figure
1, Figure
2) On July 19, 2007, the patient experienced persistent chest pain
lasting 2 hours, and he was diagnosed as acute anterior myocardial infarction
in another hospital .The patient was received intravenous thrombolytic
therapy with 2 million units of Urokinase, peak creatine kinase was 5880
U/L,and creatine kinase-MB 439.7 U/L. One day after the myocardial infarction,
he was transferred to our hospital.
- Relevant catheterization findings:
Twelve days after AMI,coronary angiography was repeated, (Figure
3, Figure
4) and the result was similar to two months ago. OCT was performed
in SES location of LAD. OCT showed aneurysm, stent strut malapposition
in the SES location. (Figure
5)
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