Late Stent Thrombosis After Drug-Coated Balloon Coronary Angioplasty for In-Stent Restenosis A Case Report

A 41-year-old woman with chest pain for 6 hours was admitted to our chest pain center, presenting with acute myocardial infarction. Coronary angiography showed acute total occlusion in the proximal left anterior descending artery due to late stent thrombosis. After thrombus aspiration and intracoron...

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Bibliographic Details
Published inInternational Heart Journal Vol. 62; no. 1; pp. 171 - 174
Main Authors Wang, Wenjun, Wang, Bailu, Chen, Yuguo, Wei, Shujian
Format Journal Article
LanguageEnglish
Published Tokyo International Heart Journal Association 30.01.2021
Japan Science and Technology Agency
Subjects
Angiography
Angioplasty
Antiplatelet strategy
Aspirin
Chest
Clopidogrel
Coronary artery disease
Cytochrome P450
Gene mutation
Genetic screening
Implants
Medical imaging
Myocardial infarction
Occlusion
Pain
Restenosis
Stenosis
Stents
Thrombosis
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Summary:A 41-year-old woman with chest pain for 6 hours was admitted to our chest pain center, presenting with acute myocardial infarction. Coronary angiography showed acute total occlusion in the proximal left anterior descending artery due to late stent thrombosis. After thrombus aspiration and intracoronary administration of 0.5 mg tirofiban, repeated angiography showed that no obvious residual stenosis remained. The patient underwent drug-coated balloon angioplasty 69 days ago and was then administered dual antiplatelet treatment (aspirin and clopidogrel) uninterruptedly. Genetic testing found that both cytochrome P450 2C19 (CYP2C19) (G681A) and glycoprotein Ia (GPIa) (C807T, G873A) were hybrid mutant types, demonstrating that the patient was possibly resistant to clopidogrel and aspirin simultaneously. Thus, clopidogrel was replaced by ticagrelor and no more cardiovascular adverse events occurred during the 2-year follow-up.
ISSN:1349-2365
1349-3299
DOI:10.1536/ihj.20-309