Summary
A 63 year old male presents with anterior ST elevation myocardial infarction. Two years prior he had PCI with DES to the proximal left anterior descending (LAD) and circumflex arteries following an abnormal stress test. Clopidogrel was discontinued several weeks prior to this presentation.
Highlights
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Recognizing stent thrombosis as a cause of ST elevation myocardial infarction
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Utilizing intracoronary imaging such as optical coherence tomography (OCT) to guide therapy in stent thrombosis
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Diagnosing stent malapposition as a cause of acute coronary syndrome
He was taken emergently to the cardiac catheterization lab and via right radial approach found to have acute stent thrombosis of LAD and circumflex arteries ( Fig. 1 ). Attention was initially directed to the circumflex, and aspiration thrombectomy along with predilation with a 3 × 12 mm balloon was performed. TIMI 3 flow was restored. The circumflex wire was left in place and the LAD was wired. There was initially some difficulty passing the thrombectomy catheter and balloon. Prowater guidewire was changed for a PT 2 guidewire and positioned in the distal LAD. Balloon dilation with a 2.5 × 12 mm balloon restored flow to the LAD.
