The Inhibitory Effect of Platelet Aggregation Ability Assessed by the Platelet Aggregatory Threshold Index in a Patient with Recurrent Stent Thrombosis

Figures

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  Figure 1.. Coronary angiograms and intravascular ultrasound images gathered over the course of treatment of a patient who underwent a percutaneous coronary intervention and stent placement. The arrows show sites of each intravascular ultrasound image. (A) Prior to the initial percutaneous coronary intervention. Moderate to severe stenosis is visible (instantaneous wave-free ratio: 0.82) in the left anterior descending coronary artery. (B) After intraoperative inflation of a scoring balloon, we checked for the presence of cracks and ensured acceptable dilatation of the vessel. (C) During the same surgery, a drug-coated stent was implanted. (D) Coronary angiogram image taken after implantation of the drug-coated stent.

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  Figure 2.. Patient electrocardiograms (ECGs) over the course of treatment of a patient who suffered recurrent stent thrombosis. (A) The patient’s initial ECG was almost normal. (B) On postoperative day 8 after stent implantation, an ECG showed new-onset stent thrombosis (ST) elevation in the anterior lead. (C) The patient's ECG at discharge after hospital admission for the surgery was close to baseline. (D) On postoperative day 69, an ECG again showed ST elevation in the anterior lead.

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  Figure 3.. Coronary angiograms and intravascular ultrasound images obtained at the first and second occurrence of recurrent stent thrombosis in a patient who underwent stent placement for stenosis of the left anterior descending coronary artery. (A) Occlusion of the left anterior descending coronary artery. Arrows show the sites of each intravascular ultrasound image. (B) Improvement of coronary flow after thrombus aspiration and balloon dilatation. (C) Second occlusion at the left anterior descending coronary artery (arrow). (D) Final coronary angiogram after the third percutaneous intervention.

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  Figure 4.. Platelet aggregation threshold index (PATI) of whole-blood aggregometry and grading curve and grade type (G-type) evaluation after the second stent thrombosis. (C-E) At days 75, 89, and 205, the patient presented with an amelioration of the PATI ≥4.0 μM, and G-type ≤-1, judging to be sufficient for platelet aggregation.