Subacute Stent Thrombosis Occurring More Than One Month after Implantation for Acute Myocardial Infarction

Abstract

Two patients are described with anterior acute myocardial infarction who had a successful recanalization of a totally occluded left anterior descending coronary artery by means of primary angioplasty and stenting. Reinfarction occurred more than 1 month after implantation. At angiography, a totally occluded left anterior descending coronary artery at the site of stenting was observed and was effectively reopened with angioplasty and stenting in both cases. This report aims to emphasize that acute myocardial infarction still represents a major risk factor for subacute stent thrombosis and that this potentially catastrophic event may occur late after implantation. Potential implications for revascularization strategies and medical treatment are discussed.

Late stent thrombosis in the nonbrachytherapy population: A real phenomenon?

“…These cases have occurred just beyond 30-day poststent placement [18,20,21] and several months later [19]. The loss of the antiplatelet effect either alone or in combina-tion with another factor such as incomplete endothelialization may have played a role in the pathogenesis of LST in these cases.…”

“…This heightened awareness of the phenomenon of LST appears to have provided the impetus to investigators to extend the search for cases of LST in registry and trial databases outside of the setting of intracoronary radiation therapy [14 -16]. Further LST events have also been reported from the long-term follow-up of the placebo arms of radiation studies [17] and as case studies [17][18][19][20][21]. Despite the fact that the absolute number of LST events reported is relatively small, the data suggest that LST is indeed a real phenomenon in the nonbrachytherapy population (Table II).…”