Very Late Mesenteric Bare Metal Stent Thrombosis in the Setting of Cessation of Antiplatelet Agents

• Published in: Heart, lung & circulation lung & circulation, 2015-06, Vol.24 (6), p.e65-e67
• Main Authors: Ait-Mokhtar, O, Bayet, G, Benamara, S, Brunet, J, Hager, F.X, Sainsous, J
• Format: Article
• Language: English
• Subjects: Acute mesenteric ischaemia; Aged; Angiography - methods; Angioplasty, Balloon - methods; Atherothrombosis; Cardiovascular; Endovascular therapy; Follow-Up Studies; Humans; Male; Mesenteric Ischemia - diagnostic imaging; Mesenteric Ischemia - therapy; Metals; Periphery artery disease; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Prosthesis Failure; Recurrence; Retreatment - methods; Risk Assessment; Severity of Illness Index; Stents - adverse effects; Tomography, X-Ray Computed - methods; Treatment Outcome; Very late stent thrombosis; Withholding Treatment
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2014.11.028

We report a case of a 73 year-old man admitted for acute mesenteric ischaemia. Eight years before, he had a first mesenteric ischaemic event treated by left colectomy and angioplasty of both main coeliac artery (MCA) and superior mesenteric artery (SMA); the patient was discharged on lifelong clopidogrel and aspirin. One month before his admission for the index event, he had a major haematuria; clopidogrel was stopped first, then aspirin because of recurrent haematuria. Five days after withdrawal of both antiplatelet drugs, the patient presented with acute mesenteric ischaemia. Urgent aortography showed in-stent occlusion of SMA and in-stent restenosis of MCA; we performed ad hoc thrombus aspiration of SMA and balloon angioplasty of MCA. The patient was discharged seven days after, without complications. This case shows that very late stent thrombosis in digestive artery can occur in the setting of antiplatelet arrest and urgent endovascular intervention constitutes a seductive alternative for surgery when performed early after symptoms onset.