A case of coronary artery disease with antiphospholipid syndrome that showed repeated stent thrombosis

Abstract

A 55-year-old man with severe chest pain was hospitalized for acute coronary syndrome. Coronary angiography revealed total occlusion of his left anterior descending coronary artery, which was successfully recanalized by percutaneous coronary intervention (PCI). However, the patient subsequently experienced subacute stent thrombosis, restenosis in the stent, and frequent thrombosis in PCI toward restenosis. Primary antiphospholipid syndrome should be considered as a possible cause of repeated stent thrombosis, and, if salvage by PCI is impossible, salvage by coronary artery bypass graft should be considered.

Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report

“…APS is found in up to 5% of the general population and up to 30% of patients with SLE. One of the many clinical manifestations of APS is valvular heart disease [1,3]. Heart valve disease appears in 14,3% of patients with APS and is defined by the presence of irregular nodules or vegetations, and moderate to severe valve dysfunction in the absence of a history of rheumatic fever or infective endocarditis [2,3].…”

“…Although the pathophysiology is not yet fully understood, it is believed that APS, causes immune complexes that injure the valvular endothelium causing fibrotic changes on the valve [ 1 , 2 ]. Heart valve disease in the setting of APS is related to a 10-fold increase in the risk of stroke [ 3 , 5 , 6 ]. The damage to the valve is regularly mild, and the likelihood of developing heart valve disease is around 8%.…”

“…The damage to the valve is regularly mild, and the likelihood of developing heart valve disease is around 8%. When it occurs, valve replacement surgery is needed in up to 6% of these patients [ 3 , 5 , 7 ]. In asymptomatic patients with AS, surgery is recommended when the left ventricular ejection fraction is less than 50% or when exercise stress tests are abnormal and should be considered when the mean pressure gradient is beyond 60 mmHg, the aortic jet velocity is above 5 m/s, there is evidence of a left ventricular hypertrophy, elevated B-type natriuretic peptide and reduced global left ventricular strain in low-risk patients [ 8 , 9 ].…”

“…When APS damage a heart valve, surgery becomes a challenging situation [1,2]. Perioperative treatment and surgical planning become critical steps as the medical team must be adequately qualified to face possible complications and give the necessary long-term treatment and follow up [1,3].…”

Therapeutic challenges after successful thrombectomy in a patient with an antiphospholipid syndrome associated M1-occlusion: A case report

“…The complications of cardiac stent thrombosis are described in a few case reports. 19,20 To our knowledge this is the first report of mechanical thrombectomy with stent implantation with further therapeutic challenges in a patient with APS and acute stroke.…”