A Stent Thrombosis 1465 Days After Implantation
A 60-year-old man, a smoker presented with two hours after the beginning of chest pain. The patient had undergone PCI for the deployment of a SES (2.75mm diameter, 28 mm long) in the left anterior descending coronary artery (LAD) in 2006. He took clopidogrel for 6 months and continued taking aspirin. The physical examination was unremarkable. The ECG showed ST segment elevation in anterior leads. Coronary angiography elicited a total occlusion of the SES (Figure ). A loading dose of 600 mg clopidogrel, heparin (10.000IU) and a glycoprotein IIb/IIIa antagonist (tirofiban) were administered. After manually aspiration of the thrombus, a BMS (3.0 mm diameter, 32 mm long) was implanted at 14 atm. The chest pain resolved quickly and good TIMI3 flow in LAD was achieved (Figure ). The hospital course was uneventful and the patient was discharged four days later in good condition. He has been advised to continue on aspirin and clopidogrel indefinitely.