Subacute stent thrombosis presented atypically as out-of-hospital asystole and ventricular tachycardia storm in a 58-year-old male 10 days post-PCI, despite dual antiplatelet therapy compliance.
Case Report (n=1)
Subacute stent thrombosis can present atypically as sudden cardiac arrest and ventricular tachycardia storm without classic ischemic symptoms, requiring a high index of suspicion and multidisciplinary critical care.
Abstract Stent thrombosis is a rare but serious complication of drug-eluting stent (DES) implantation, associated with a high mortality rate. Patients typically present with chest pain and dyspnea. Mechanisms include delayed re-endothelialization, medication non-compliance and mechanical issues We report a 58-year-old male who presented in out-of-hospital asystole 10 days following percutaneous coronary intervention (PCI). A 58-year-old male presented to the emergency department with asystole. Early July, the patient underwent DES placement for an acute ST-elevation myocardial infarction and remained fully compliant with dual antiplatelet therapy. Platelet function testing showed no evidence of clopidogrel resistance. Ten days later, he re-presented to the emergency department following an out-of-hospital asystole. ECG showed new 1 mm ST-segment elevation in lead III with reciprocal ST depressions in leads V2-V4. Plans were made for non-emergent catheterization. Later that morning, the patient developed pulseless ventricular tachycardia/fibrillation, which resolved with ACLS. He denied chest pain but reported diaphoresis, EKG remained unchanged. He was urgently taken for catheterization, where stent thrombosis was identified. Post-dilation of the stent was performed, and coronary blood flow restored. Despite this, the patient experienced multiple episodes of pulseless VT. An amiodarone drip was initiated, followed by a lidocaine infusion. He was eventually intubated and sedated to reduce sympathetic stimulation. However, he continued to experience VT. Ultimately, he was transferred to a tertiary ICU for advanced care. This case highlights the fatal course of subacute stent thrombosis. Notably, our patient exhibited none of the classic symptoms, instead presenting with sudden cardiac arrest and VT storm. This illustrates the importance of maintaining a high index of suspicion for stent thrombosis in post-PCI patients, even in the absence of typical ischemic symptoms. Early recognition and prompt revascularization are critical; however, severe arrhythmic complications may persist despite restoration of coronary flow. The case emphasizes the vital role of multidisciplinary critical care support in the management of complex post-PCI complications. This abstract is funded by: None
Abdulle et al. (Fri,) conducted a case report in Subacute stent thrombosis (n=1). Percutaneous coronary intervention was evaluated. Subacute stent thrombosis presented atypically as out-of-hospital asystole and ventricular tachycardia storm in a 58-year-old male 10 days post-PCI, despite dual antiplatelet therapy compliance.