Very Late Bare Metal Stent Thrombosis: What Can Be The Role of Instent Re-stenosis and Hyperhomocysteinemia?

Abstract

A 62-years old man was admitted to emergency department suffering from chest pain. Resting ECG revealed ST elevation on inferior leads and he was diagnosed with acute inferior myocardial infarction. His past medical history revealed that a bare metal stent had been implanted in his circumflex coronary artery upon stable angina pectoris 45 months ago. Immediately performed coronary angiography demonstrated the occlusion of the stent in the circumflex coronary artery. A new bare metal stent was implanted and TIMI 3 flow was established after initial balloon angioplasty. No other causes but vitamin B12 deficiency and hyperhomocysteinemia were found for this non-smoker patient among other laboratory tests.

Keywords

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Çok Geç Dönem Çıplak Metal Stent Trombozu: Stent İçi Restenozun ve Hiperhomosisteineminin Rolü Ne Olabilir?

Abstract

Altmışiki yaşındaki erkek acil servise göğüs ağrısı şikayeti ile kabul edildi. İstirahat elektrokardiyografisinde inferior derivasyonlarda ST yükselmesi saptaması üzerine hastaya akut inferior miyokard infarktüsü tanısı konuldu. Hastadan edinilen tıbbi hikaye doğrultusunda 45 ay öncesinde başka bir merkezde kararlı angina pektoris kliniği ile sirkumfleks koroner arterine çıplak metal stent takıldığı öğrenildi. Acil yapılan koroner anjiografisinde sirkumfleks arterdeki önceki stentin akut oklüzyonu saptandı. Balon anjioplasti ardından yeni bir çıplak metal stent implante edilerek sirkumfleks arterde TIMI-3 akım elde edildi. Sigara kullanmadığı bilinen hastada tromboz etyolojisini saptamak amaçlı yapılan testler sonucunda vitamin B12 eksikliği ve hiperhomosisteinemi saptandı.

Keywords

• Stent, Tromboz, Miyokard infarktüsü

References

1. Cutlip DE, Windecker S, Mehran R, et al. Academic Research Concortium. Circulation 2007; 115: 2344-2351.
2. Holmes DR Jr, Kereiakes DJ, Garg S, et al. Stent thrombosis. J Am Coll Cardiol 2010; 56: 1357-1365.
3. Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 2003; 108: 1701-1706.
4. Lemesle G, Pinto Slottow TL, Waksman R. Very late stent thrombosis after bare-metal stent implantation: case reports and review of the literature. J Invasive Cardiol 2009; 21: 27- 32.
5. Bertrand OF, Rodes-Cabau J, Poirier P. Very late in-stent restenosis (five years) presenting as an ST elevation acute myocardial infarction. Can J Cardiol 2004; 20: 1481-1483.
6. Trabattoni D, Bartorelli AL. Late occlusive in-stent restenosis of a bare-metal stent presenting with ST-elevation anterior MI: Is restenosis better then a late stent thrombosis? Int J Cardiol 2009; 135: 65-67.
7. Danenberg HD, Lotan C, Hasin Y, Gotsman MS, Rozenman Y. Acute myocardial infarction- a late complication of intracoronary stent placement. Clin Cardiol 2000; 23: 376- 378.
8. Celik T, Iyisoy A, Kursaklıoglu H. A case of late stent thrombosis after exercise electrocardiography: Exercise- or residual plaque –induced? J Invasive Cardiol 2005; 17: 280- 282.

9. Chen MS, John JM, Chew DP, Lee DS, Ellis GS, Bhatt DL. Bare metal stent restenosis is not a benign clinical entity. Am Heart J 2006; 151: 1260-1264.
10. Nayak AK, Kawamura A, Nesta RW, et al. Myocardial infarction as a presentation of clinical in-stent restenosis. Circ J 2006; 70: 1026-1029.
11. Welch G, Loscalzo J. Homocystein and atherothrombosis. N Engl J Med 1999; 338: 1042-1050.
12. Tsai JC, Perrella MA, Yoshizumi M, et al. Promotion of vascular smooth muscle cell growth by homocysteine: a link to atherosclerosis. Proc Natl Acad Sci USA 1994; 91: 6369– 6373.
13. Morita H, Kurihara H, Yoshida S, et al. Diet-induced hyperhomocysteinemia exacerbates neointima formation in rat carotid arteries after balloon injury. Circulation 2001; 103: 133–139.