Simultaneous double-culprit in-stent thrombosis. Who is the guilty prisoner behind bars: drug-eluting stent, bare-metal stent, or indication for treatment?

• Published in: Cardiovascular revascularization medicine 2006-10, Vol.7 (4), p.258-263
• Main Authors: Mezzapelle, Giuseppe, Baglini, Roberto, Baldari, Duccio
• Format: Article
• Language: English
• Subjects: Acute stent thrombosis; Antithrombin III deficiency; Antithrombin III Deficiency - complications; Aspirin - therapeutic use; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - etiology; Coronary Restenosis - prevention & control; Double platelets antiaggregation; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Recurrence; Risk Factors; Stents - adverse effects; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2006.06.001

The intrinsic thrombogeneity of stents was the historic limitation to their usage during the early phases of stenting. The risk of stent thrombosis has been minimized by the widespread use of platelet antiaggregation. Nowadays, the risk of subacute stent thrombosis is around 1%. Thrombotic risk depends on several factors, such as type of stent, complexity of lesion, and clinical picture. We present a case of recurrent acute in-stent thrombosis in a patient with mild antithrombin III (AT) deficiency despite the combined administration of clopidogrel and aspirin. In our patient, several factors, such as diabetes, AT deficiency, and the use of a paclitaxel-eluting stent, have contributed to the development of recurrent acute stent thrombosis. Although we were not able to identify the culprit factor, we should keep in mind that the deployment of a drug-eluting stent could be unsafe if it is not supported by a clear clinically oriented pathway that considers the overall condition of the patient since, in some cases, neither coronary lesions nor coronary stents are responsible for the negative outcome of patient therapy, which may be caused instead by incomplete or inadequate patient assessment.