Why the study?
Stent thrombosis and lead perforation are important differentials to consider in patients presenting with chest pain following recent coronary stent and pacemaker insertion.
This case highlights the importance of maintaining a high index of suspicion for multiple concurrent post-procedural complications, such as lead perforation and stent thrombosis, in patients presenting with chest pain after recent PCI and pacemaker implantation.
May prompt vigilance for concurrent post-procedural complications in chest pain patients; leaves open prospective validation of CT diagnostics.
Stent thrombosis and lead perforation are important differentials for patients presenting with chest pain following recent coronary stent insertion and pacemaker insertion. In this report, we describe an unusual case of a 78-year-old male who presented with sharp chest pain one week after admission for posterior ST-elevation myocardial infarction (STEMI) and subsequent Mobitz type II block, for which he received primary percutaneous coronary intervention (PPCI) to the left circumflex artery (LCx) and dual chamber permanent pacemaker (PPM) insertion. Computed tomography (CT) chest and CT coronary angiogram (CTCA), respectively, showed he had concurrent lead perforation and stent thrombosis. On balance, the cause of chest pain was likely lead perforation. This diagnosis was reached by having a high index of suspicion for both of these important post-procedure complications and investigating appropriately.
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Shaikh et al. (2023) studied this question.
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