Stent thrombosis after PCI is a catastrophic problem and occurs about % 1-2 of total PCI cases. Although the incidence of ST is relatively low, prognosis of ST is dismal; with a case-mortality rate of % 15-45. We report a case of acute stent thrombosis during PCI for one patient with stable angina pectoris, which was successfully treated with balloon inflation and intracoronary/ intravenous injection of glycoprotein IIb/IIIa inhibitor.

76 year old man was referred to our hospital with complaints of chest pain and dyspnea on exertion (New York Heart Association functional class III) from 3 months ago. According to his medical records, balloon angioplasty was performed in 2008 because of LAD stent restenosis which was implanted in 1999. He was a diabetic patient and also taking asetil salicylic acid, beta blocker and statin. Echocardiographic examination showed hypokinesia of the anterior wall at mid to apical portion of left ventricle. Exercise myocardial perfusion study revealed ischemia of left ventricle apical segment. He was underwent diagnostic coronary angiography which showed critical stent restenosis of middle LAD. Other coronary arteries were unremarkable in terms of coronary artery disease and ad hoc PCI was decided to perform for LAD stent restenosis. 600 mg clopidrogel, 300 mg aspirin and 7500 IU unfractionated heparin were administered before PCI. After predilation, sirolimus eluting stent (2,5 x 33 mm Combo stent, Orbusneich) was inserted in LAD stent and postdilation was performed with a non compliant balloon. After PCI, patient suddenly complained of chest pain and he was also hypotensive. We checked the coronary angiography and found newly developed intraluminal filling defect due to stent thrombosis of the distal LAD stent. Glycoprotein IIb/IIIa receptor blocker (Tifofiban) was started via intracoronary bolus dose continued with intravenous infusion. (2.5 x 9 mm Simchrome stent, Sesa) was implanted beyond to the distal LAD stent. No-reflow phenomenon was developed. Consecutive balloon inflation (2,25 x 26 mm) was performed distal to proximal LAD and TIMI 3 coronary flow was achieved however, image of thrombus was persisted. After medical treatment with LMWH for 7 days, thrombus image was disappeared completely and patient was discharged with dual anti-platelet therapy using 100 mg aspirin and 75 mg ticagrelor twice daily.

Physicians should consider acute stent thrombosis especially for patients having new onset or aggravation chest pain or sudden abnormal findings during PCI.