Key result
Case report details rare recurrent simultaneous two-vessel very late DES thrombosis in a 43-year-old male.
Why the study?
Very late stent thrombosis simultaneously in two arteries using second-generation DES is extremely rare.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
This case highlights the rare and catastrophic occurrence of recurrent simultaneous two-vessel very late stent thrombosis, emphasizing the potential need for prolonged dual antiplatelet therapy in high-risk patients.
Kontext: TrombĂłza stentu mĂĄ katastrofĂĄlnĂ dĹŻsledky. NovĂĄ generace lĂŠkovĂ˝ch stentĹŻ (drug eluting stent, DES) pĹinesla vĂ˝znamnĂŠ zlepĹĄenĂ ĂşÄinnosti a hlavnÄ bezpeÄnosti. Velmi pozdnĂ trombĂłza stentu je sice vzĂĄcnou komplikacĂ, ale jeĹĄtÄ vzĂĄcnÄjĹĄĂ je velmi pozdnĂ trombĂłza stentu souÄasnÄ ve dvou tepnĂĄch pĹi pouĹžitĂ DES druhĂŠ generace. Kazuistika: V roce 2018 byl do naĹĄĂ nemocnice pĹijat 43letĂ˝ muĹž pro infarkt myokardu bez elevacĂ ĂşsekĹŻ ST (non-ST elevation myocardial infarction, NSTEMI) pro vĂ˝znamnĂŠ zmÄny na proximĂĄlnĂch segmentech ramus interventricularis anterior (RIA) a ramus circumflexus (RCx) ĹeĹĄenĂŠ implantacĂ dvou DES. Po dvou letech bez problĂŠmĹŻ byl muĹž znovu pĹijat do nemocnice pro infarkt myokardu pĹednĂ stÄny s elevacemi Ăşseku ST (ST-elevation myocardial infarction, STEMI). Koronarografie prokĂĄzala vĂ˝znamnĂŠ stenĂłzy dvou dĹĂve oĹĄetĹenĂ˝ch tepen. Byla provedena primĂĄrnĂ perkutĂĄnnĂ koronĂĄrnĂ intervence (percutaneous coronary intervention, PCI) s implantacĂ stentĹŻ uvolĹujĂcĂch sirolimus do RIA a RCx. Pacient nĂĄslednÄ uĹžĂval kyselinu acetylsalicylovou v dĂĄvce 100 mg a clopidogrel v dĂĄvce 75 mg dennÄ po dobu jednoho roku. V dubnu roku 2021 se pacient dostavil na oddÄlenĂ urgentnĂho pĹĂjmu pro nepolevujĂcĂ svĂravou bolest na hrudi. Elektrokardiogram prokĂĄzal infarkt pĹednĂ stÄny myokardu s elevacemi Ăşseku ST. BÄhem dvou hodin od nĂĄstupu symptomĹŻ byl muĹž pĹevezen na katetrizaÄnĂ sĂĄl. K naĹĄemu pĹekvapenĂ byla zodpovÄdnĂĄ lĂŠze pĹĂtomna na stejnĂ˝ch dvou tepnĂĄch. Do RIA jsme implantovali stent 4 Ă 25 mm uvolĹujĂcĂ sirolimus a lĂŠze na RCx byla oĹĄetĹena non-compliantnĂm balonkem 3 Ă 20 mm nafouknutĂ˝m na 14 atm. V obou pĹĂpadech pacient uĹžĂval jako antiagregaÄnĂ lĂŠÄbu kyselinu acetylsalicylovou po 12 mÄsĂcĂch duĂĄlnĂ antiagregaÄnĂ lĂŠÄby. AĹž na citovĂŠ vypÄtĂ pĹedchĂĄzejĂcĂ obÄma pĹĂhodĂĄm nebyl zjiĹĄtÄn ŞådnĂ˝ spouĹĄtÄcĂ faktor. ZĂĄvÄr: Velmi pozdnĂ trombĂłza stentu v dĹŻsledku sloĹžitĂ˝ch mechanismĹŻ pĹedstavuje pĹĂhodu s katastrofĂĄlnĂmi dĹŻsledky. Tato kazuistika popisuje vzĂĄcnou formu rekurentnĂ, velmi pozdnĂ trombĂłzy stentu a je ve shodÄ s nedĂĄvno publikovanĂ˝mi doporuÄenĂ˝mi postupy (guidelines), v nichĹž se navrhuje vytvoĹit kategorii pacientĹŻ s vysokĂ˝m rizikem ischemie, kteĹĂ vyĹžadujĂ dlouhodobou duĂĄlnĂ antiagregaÄnĂ terapii. © 2022, ÄKS.
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Bennour et al. (2022) conducted a case report in Recurrent simultaneous two-vessel very late stent thrombosis (n=1). Percutaneous coronary intervention with sirolimus-eluting stents was evaluated. A 43-year-old male experienced a rare recurrent simultaneous two-vessel very late stent thrombosis in the left anterior descending and circumflex arteries after drug-eluting stent implantation.
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