RECURRENT SUBACUTE IN STENT THROMBOSIS - BAD LUCK?

64 years old male smoker with history of MI (anterior wall 10 years ago) was admitted to our hospital for direct PCI (chest pain lasting 5 hours, elevation of ST segment on EKG). On admission advanced heart failure indicated artificial ventilation. Direct PCI of circumflex branch (thrombotic occlusion) with implantation of 2 stents was performed. Two days later patient was transferred to the local hospital.

Two days later it was necessary to perform new direct PCI due to incoming STEMI in the same location (thrombotic reocclusion) and the other reintervention we had to perform 5 days later. All together 4 stents have been implanted, during the second reocclusion abciximab was applied. This hospitalization lasted 23 days, all complications (pneumonia and heart failure) have been treated and whole this time patient has been treated by LMWH, clopidogrel and aspirin. On the 23rd day patient was discharged. Six months later patient is feeling O. K., functional class NYHA II, ejection fraction of left ventricle has been only slightly dropped in comparison with the value on the first admission. Laboratory tests did not discover any coagulopathy or homeostasis dysbalance.

Conclusion: PCI must be done with maximal attention paid to optimalization of the technique, if it is possible the IVUS examination is preferable and if it cannot be done the high pressure post dilatation should be applied. It is extremely important carefully examine the result even in the areas surrounding stents. In the case of thrombotic occlusions pharmacotherapy should be optimized.

Keywords: acute coronary syndrome, subacute thrombosis, percutaneous coronary intervention.