1. Acute and Subacute Stent Thrombosis in a Patient With Clopidogrel Resistance: A Case Report
- Author
-
Kyung Hun Cho, Ju Han Kim, Min Chul Kim, Soo Young Bae, Doo Sun Sim, Jung Chaee Kang, Keun Ho Park, Sung Soo Kim, Kyoung Ho Ryu, Youngkeun Ahn, H Y Kim, Myung Ho Jeong, and Young Joon Hong
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,Chest pain ,Coronary artery disease ,Internal medicine ,Angioplasty ,Internal Medicine ,medicine ,Myocardial infarction ,cardiovascular diseases ,Cardiac catheterization ,business.industry ,Stent ,Thrombosis ,Clopidogrel ,medicine.disease ,Surgery ,surgical procedures, operative ,Cardiology ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,TIMI ,medicine.drug - Abstract
Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.
- Published
- 2009