The potential hazard of drug-eluting stent-induced coronary vasospasm causing subacute stent thrombosis: a case report

Figures

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  Fig. 1. Pre-intervention coronary angiography. The left coronary artery showed intermediate stenosis in the proximal left ascending artery and left circumflex artery. Fractional flow reserve was 0.77 and 0.79 in the left ascending artery and left circumflex artery, respectively. AP anterior-posterior, RAO right anterior oblique

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  Fig. 2. Elective percutaneous coronary intervention to the left ascending artery (a and b) and intravascular ultrasound findings (c-f). a Implantation of an everolimus-eluting stent (3.25 mm in diameter, 33 mm in length). b Final angiogram after post-dilatation, indicating good blood flow. c-f Intravascular ultrasound findings of the implanted everolimus-eluting stent (c proximal part of the stent, d part of first diagonal branch, e part of second diagonal branch, f distal part of the stent) indicating that the stent was well-expanded and without incomplete apposition

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  Fig. 3. Emergent coronary angiography and percutaneous coronary intervention for subacute stent thrombosis. a and b Total occlusion of the proximal part of the stent with thrombus. c and d Aspiration thrombectomy and balloon angioplasty (high-pressure balloon, 3.25/15 mm) were performed. e and f Final coronary angiogram, indicating TIMI grade 3 flow. POBA plain old balloon angioplasty

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  Fig. 4. The spasm provocation test. a and b Baseline coronary angiography. c and d Intracoronary infusion of ergonovine induced a severe spasm in the left coronary artery, except for the stented lesion; the left circumflex artery was occluded. e and f Intracoronary infusion of isosorbide dinitrate completely resolved the coronary vasospasm. EES everolimus-eluting stent, Erg ergonovine, ISDN isosorbide dinitrate