In-stent Massive Thrombi Formation During Primary Percutaneous Coronary Intervention in a Patient with Acute Myocardial Infarction Complicated with Essential Thrombocythemia

Figures

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  Figure 1.. Findings of initial and post-reperfusion CAG. Initial and post-reperfusion CAG findings are shown. The right coronary artery (A, B) and left circumflex coronary artery had no severe stenosis. There was total occlusion from the LAD ostium (C, D, E). Initial CAG after recanalization showed thrombolysis in myocardial infarction (TIMI) grade II flow in the LAD (F).

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  Figure 2.. Findings of CAG and IVUS immediately after deploying a DES at primary PCI. CAG immediately after deploying a DES revealed a lot of defects in the stent (A, B, C). IVUS showed multiple thrombi in the whole stent and near the stent distal edge (D, E, F white arrow). Figure G is an enlarged version of Fig. B. The arrowheads of D, E, and F in Fig. G indicate the points of the IVUS images of Fig. D, E, and F. Final CAG revealed a reduction of thrombi in the stented lesion and thrombolysis in myocardial infarction (TIMI) grade III flow in the LAD (H, I).

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  Figure 3.. Findings of CAG and OFDI 2 days later after primary PCI. We performed CAG and OFDI two days after primary PCI. In OFDI, we noted remnant thrombi (A, white arrow) and incomplete stent apposition in the LM (A, yellow arrow) and no thrombi and complete apposition in the LAD (B). Intimal dissection and thrombi were observed near the stent distal edge (C). The arrowheads of A, B, and C in Fig. D showed points of OFDI views of Fig. A, B, and C. The thrombus was retrieved using an aspiration catheter from the coronary artery (E, arrowhead) and guiding catheter (E, small arrow).

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  Figure 4.. Findings of follow-up CAG and OFDI nine months later. Follow-up CAG nine months later revealed no in-stent restenosis. In addition, the moderate stenosis in the mid LAD had improved (A, B, C). OFDI showed that the stent was completely covered with neointima over the full length with no thrombi from the LM to the LAD. (D, E, F). The arrowheads of D, E, and F in Fig. G showed points of OFDI views of Fig. D, E, and F.