Volume 3, Issue 2, June 2019, Page: 31-36
Intraprocedural Stent Thrombosis: Case Series of a Rare Complication Managed Successfully
Nikesh Jain, Jaslok Hospital and Research Centre, Mumbai, India
Nilesh Tawade, Narayana Institute of Cardiac Sciences, Bangalore, India
Nihar Mehta, Jaslok Hospital and Research Centre, Mumbai, India
Ajit Desai, Jaslok Hospital and Research Centre, Mumbai, India
Ashwin Mehta, Jaslok Hospital and Research Centre, Mumbai, India
Received: May 1, 2019;       Accepted: Jun. 10, 2019;       Published: Jun. 26, 2019
DOI: 10.11648/j.ccr.20190302.13      View  115      Downloads  19
Abstract
Intra-procedural stent thrombosis (IPST) is defined as the development of occlusive or non-occlusive new thrombus in or adjacent to a recently implanted stent before the PCI procedure is completed. The frequency of occurrence currently ranges between 0.5 – 1.7% of all PCI procedures and it seems to be considerably reduced with newer drug eluting stents and improved techniques. The occurrence of IPST is relatively rare, even in ACS patients, and is related strongly to clinical presentation and procedural factors (e.g., anticoagulation regimen, lesion type, presence of thrombus at baseline, stent under expansion and edge dissection etc.) than to baseline demographic characteristics. Imaging modalities like IVUS or OCT can prevent as well as identify the underlying cause for IPST. IPST not only decreases success rate of PCI but is also associated with higher rates of slow flow or no reflow, distal embolization and side branch closure. It is also associated with higher mortality, myocardial infarction, ischemia driven revascularisation and stent thrombosis on follow up. IPST can be managed immediately in cath lab and involves use of GP2b3a inhibitors, optimising stent apposition by repeat balloon dilatation, use of imaging to identify the cause and accordingly corrective measures to be taken. Rarely emergency CABG may be required if underlying cause cannot be corrected. Prevention is the key. IPST can be prevented by using newer anti-platelets, use of GP2b3a inhibitors especially in presence of ACS or high thrombus load, preparing the lesion well before stenting, use of atherectomy devices when needed, appropriate stent size selection and use of imaging modalities in complex lesions to optimise stent selection and apposition. We describe three cases of the intra procedural stent thrombosis under different clinical scenarios and its management.
Keywords
Intraprocedural Stent Thrombosis, Intravascular Imaging, Newer Anti Platelets
To cite this article
Nikesh Jain, Nilesh Tawade, Nihar Mehta, Ajit Desai, Ashwin Mehta, Intraprocedural Stent Thrombosis: Case Series of a Rare Complication Managed Successfully, Cardiology and Cardiovascular Research. Vol. 3, No. 2, 2019, pp. 31-36. doi: 10.11648/j.ccr.20190302.13
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
S J. Brener, E Cristea, A J. Kirtane., et al. Intra-procedural stent thrombosis: a new risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndromes." JACC Cardiovasc Interv 6 (1): 36-43.
[2]
A Chieffo, E Bonizzoni, D Orlic et al. Intraprocedural Stent Thrombosis During Implantation of Sirolimus-Eluting Stents. Circulation. 2004; 109: 2732-2736.
[3]
Lemesle G, Delhaye C, Bonello L, et al. Stent thrombosis in 2008: Definition, predictors, prognosis and treatment, Arch Cardiovasc Dis 101:769–777, 2008.
[4]
Ong ATL, Hoye A, Aoki J, van Mieghem CAG, et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation, J Am Coll Cardiol 45:947–953, 2005.
[5]
Cutlip DE, Baim DS, Ho KKL, et al. Stent thrombosis in the modern era: A pooled analysis of multicenter coronary stent clinical trials, Circulation 103:1967–1971, 2001.
[6]
Cheneau E, Leborge L, Mintz GS, et al. Predictors of subacute stent thrombosis: Results of a systematic intravascular ultrasound study, Circulation 108:43–47, 2003.
[7]
Uren NG, Schwarzacher SP, Metz JA, Lee DP, Honda Y, Yeung AC, Fitzgerald PJ, Yock PG. Predictors and outcomes of stent thrombosis. Eur Heart J. 2002; 23: 124–132.
[8]
Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, Dangas G, Mehran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation. J Am Coll Cardiol.2005; 45: 995–998.
[9]
Jose R, Chandrasekaran A, Sam SS, et al. CYP2C9 and CYP2C19 genetic polymorphisms: frequencies in the south Indian population. Fundam Clin Pharmacol. 2005; 19: 101e105.
[10]
Scott SA, Sangkuhl K, Gardner EE, et al. Clinical Pharmacogenetics Implementation Consortium guidelines.
[11]
A study on the impact of CYP2C19 genotype and platelet reactivity assay on patients undergoing PCI P.C. Rath, Sundar Chidambaram, Pallavi Rath et al. indian heart journal 67 (2015), 114- e121.
[12]
Anderson K M, Califf R M, Stone G W. et al Long‐term mortality benefit with abciximab in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol 2001372059–2065.2065.
[13]
P Généreux, G W Stone R A Harrington et al. Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention. JACC (Journal of the American College of Cardiology), 2014-02-25, Volume 63, Issue 7, Pages 619-629.
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