A 42-year-old man was explored by angiography after non-ST-segment elevation myocardial infarction. A monolesion was treated by direct stenting (paclitaxel-eluting stent, 3.5 × 20 mm) on the proximal left anterior descending coronary artery (LAD) and a final kissing balloon on the LAD diagonal, with an excellent result. Clinical follow-up was good (under treatment with aspirin and clopidogrel) until the patient decided to stop all antiplatelet treatment 2 years after successful stent implantation. Ten days later he was admitted for acute anterior ST-segment elevation myocardial infarction complicated by cardiogenic shock 2 hours after onset of chest pain.
Angiography showed late stent occlusion of the proximal LAD ( Fig. 1 A ). Thromboaspiration on the LAD ( Fig. 1 B), followed by the first diagonal ( Fig. 1 C), restored thrombolysis in myocardial infarction (TIMI) flow grade 3. The patient presented reperfusion syndrome. It was decided to optimize medical treatment with glycoprotein IIb/IIIa inhibitor perfusion.
