Subclinical very late thrombus formation inside and outside the everolimus-eluting stent implanted 3 years prior in a patient with provoked coronary spasms

Abstract

A 63-year-old man with non-ST-elevation acute myocardial infarction had undergone PROMUS Element stent implantation for stenosis with thrombus in the left main trunk and the proximal left anterior descending artery. A 6-month follow-up angiography revealed no restenosis or stent thrombosis, but severe provoked spasms in three vessels, for which medications were administered. Three years later, the patient experienced new-onset rest angina one morning. Optical coherence tomography revealed subclinical very late stent thromboses inside and outside the stent. The patients experienced a severe spasm. Platelet function was adequately reduced, and the cytochrome P450 2C19 genotype indicated an extensive metabolizer phenotype. The spasm may have caused the thromboses.

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

“…At present, we often perform PCI with coronary stent implantation for significant organic coronary artery stenosis. Coronary spasm occurring after coronary stent implantation has become a clinical problem [25,[102][103][104][105][106][107]. A previous report showed that excessive coronary vasoconstriction of PCI-treated coronary arteries in response to intracoronary injection of ACh was more frequent in patients treated with bare metal stents (BMS) than in those treated only with balloon angioplasty, suggesting that endothelial dysfunction induced by PCI was involved in the progression of atherosclerosis [108].…”