Case Of Acute Stent Thrombosis Research Articles

Cost-Effectiveness and Safety of Same-Day Discharge after Elective Percutaneous Coronary Intervention

Objectives: We sought to investigate the rates of same-day discharge (SDD) post elective percutaneous coronary intervention (PCI) at our institution and review its safety by examining clinical outcomes. We also performed an economic analysis evaluating our hospital’s cost data for SDD following PCI. Methods: Patients undergoing elective PCI at St George Hospital, Australia, from January 2017 to December 2019 were evaluated. Primary outcomes included 7-day major adverse cardiovascular endpoints (MACEs) and readmission to hospital within 30 days. Results: Among 502 patients who underwent elective PCI, 421 patients (83.8%) were managed with SDD. There was one case of acute stent thrombosis and one case of coronary wire-induced perforation requiring a pericardial drain that occurred following elective PCI with SDD (0.54%). Unplanned cardiac re-hospitalisation at 30 days following elective PCI was 5.2%. SDD after elective PCI was associated with a healthcare cost saving of AUD 4817 per case. Conclusion: SDD following elective PCI was demonstrated to be a safe and effective strategy that was also associated with significant cost savings. SDD following elective PCI warrants more widespread use as it lowers healthcare costs, has equivalent patient outcomes and improves patient satisfaction.

Intervenção percutânea no tronco da coronária esquerda em doença coronariana aguda e crônica. Experiência de um centro

Background Improvements in percutaneous coronary intervention have reduced complications in the treatment of left main coronary artery disease. The objective of this study was to characterize percutaneous coronary intervention procedures in left main coronary artery, and evaluate patients’ outcomes. Methods A retrospective study performed from January 2015 to December 2018, in patients submitted to percutaneous coronary intervention in left main coronary artery for stable coronary artery disease or myocardial infarction, with second-generation drug-eluting stents. Results A total of 82 patients were submitted to percutaneous coronary intervention in left main coronary artery. Among them, 26.8% had stable coronary artery disease, 50% had non-ST segment elevation myocardial infarction, and 23.2% had ST segment elevation myocardial infarction. Cardiogenic shock was present in 20.7% of them. Most patients were male, elderly, with cardiovascular risk factors, namely diabetes, hypertension and hyperlipemia. Among patients with stable coronary artery disease, patients had low to intermediate SYNTAX score. During hospitalization, patients did not develop any complications. During follow-up, cardiovascular death was of 4.5% (n=1). Regarding non-ST segment elevation myocardial infarction, during hospitalization, there were no registries of events. During follow-up, 9.1% of patients had cardiovascular-related hospitalizations. A patient died (3%) during the re-hospitalization from severe heart failure. Concerning ST segment elevation myocardial infarction patients, there was one case of acute stent thrombosis during hospitalization resulting in death. One patient was readmitted for percutaneous coronary intervention in left main coronary artery due to restenosis. Regarding the patients admitted in cardiogenic shock, in-hospital mortality was 58.8%. During follow-up, two patients experienced restenosis and were hospitalized (one underwent coronary artery bypass grafting, and the other, percutaneous coronary intervention). Conclusion This is a real-world study in which we described our experience with percutaneous coronary intervention in left main coronary artery. In general, percutaneous coronary intervention in left main coronary artery in stable left main coronary artery disease, or in unstable disease with no cardiogenic shock, was a safe procedure. Further studies with extended follow-up are needed.

Initial of acute stent thrombosis after stenting based on balloon angioplasty continuously

Acute stent thrombosis is the formation of a thrombus that obstructs the coronary lumen following stent placement. It is one of the serious complications in cardiovascular intervention with a high mortality rate. The assessment and prognosis of patients at risk of acute thrombosis after stenting plays an important role in the selection process of the intervention strategy, but careful evaluation before the intervention strategy is not avoided from acute thrombosis. Therefore, the management of acute thrombosis during the intervention plays a vital role, preventing death during the intervention. We report that a clinical case of acute stent thrombosis is successfully managed using a continuous balloon angioplasty technique to prevent thrombosis, maintain flow to perfusion myocardium, and reduce complications and mortality during acute thrombosis during the intervention.

Stent-Assisted Coiling Using Leo+ Baby Stent

BackgroundStent-assisted coiling is well-established for treatment of cerebral aneurysms. The technique enables treatment of wide-neck, bifurcation and recurrent aneurysms with high packing rates. While described in extenso for laser cut stents, the results of patients treated with the Leo+ Baby (Balt, Montmorency, France) braided microstent are presented.Material and MethodsPatients were included if treated with a Leo+ Baby and with digital subtraction angiography (DSA) follow-up available of at least 6 months. Data were evaluated for successful deployment, aneurysm occlusion according to the modified Raymond-Roy classification (MRRC), stent patency and procedure-related morbidity and mortality.ResultsA total of 81 patients were included and Leo+ Baby deployment was successful in all cases. Coils were used in 80 cases. In 1 case 2 stents were used stent-in-stent without additional coiling. Initial aneurysm occlusion rates were MRRCi1 51.9%, MRRCi2 11.1%, MRRCi3a 24.7% and MRRCi3b 12.3%. Occlusion rates after 6 months were MRRC6m1 78.9%, MRRC6m2 3.9%, MRRC6m3a 6.6% and MRRC6m3b 10.5%. Procedure-related morbidity was 1 case of acute stent thrombosis successfully treated with tirofiban and 1 case with transient hemiparesis due to stent thrombosis after 4 months. There was 1 case of coil-associated subarachnoid hemorrhage (SAH) which caused prolonged hospitalization. No procedure-related mortality was observed.ConclusionThe results confirm that stent-assisted coiling with the Leo+ Baby stent is safe and efficient for treatment of wide neck or recurrent cerebral aneurysms. Spontaneous progressive aneurysm occlusion over 6 months supports the theory of considerable flow-modulating effects of Leo+ Baby.

Real-World Experience With a Tapered Biodegradable Polymer-Coated Sirolimus-Eluting Stent in Patients With Long Coronary Artery Stenoses.

BackgroundTreatment of long coronary stenoses (LCS) with long tapered drug-eluting stents (LT-DES) would offer clinical and economic benefits. However, the feasibility of an interventional strategy based upon the systematic LCS treatment with an LT-DES has not been evaluated so far.MethodsWe performed a multicenter prospective study including consecutive patients with: 1) An LCS > 25 mm at coronary angiography; 2) An attempt to fix the LCS with a single BioMime Morph™ stent, a novel LT-DES available from 30 to 60 mm long. The primary efficacy endpoint was procedural success. The secondary safety endpoints were post-procedural TIMI3 flow, stent detachment during delivery, acute stent thrombosis and in-hospital mortality.ResultsFrom February 2017 to March 2018, we recorded 272 patients with an LCS and an attempt to deploy an LT-DES during percutaneous coronary intervention (PCI) (69.3 ± 11.4 years, 75.7% males, 25.7% diabetic and 43.8% with acute coronary syndromes, mean LCS length 48.8 ± 9.5 mm). LT-DES deployment was successful in 262 patients (96.3%), and failure occurred without stent detachment or other complications. Final TIMI3 flow was present in 270 (99.3%) patients. In-hospital death occurred in five patients (1.8%), with no case of acute stent thrombosis, recurrent myocardial infarction or repeated revascularization.ConclusionIn this real-world study, a strategy of fixing LCS with a single LT-DES was feasible and safe, with a high rate of procedural success and a low rate of in-hospital complications. More extensive randomized studies are warranted to assess the potential clinical and economic benefits of LT-DES.

Safety and efficacy of self-apposing Stentys drug-eluting stent in left main coronary artery PCI: Multicentre LM-STENTYS registry.

There is a paucity of data on left main (LM) percutaneous coronary intervention (PCI) therapy with dedicated DES platforms. The LM-STENTYS is a multicenter registry aimed at evaluating clinical outcome after PCI of LM performed with a self-apposing Stentys DES implantation. The registry consists of 175 consecutive patients treated with Stentys DES implanted to LM. The primary endpoint was the composite of major adverse cardiac and cerebral events (MACCE) defined as cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed after 1 year. The secondary endpoint was stent thrombosis (ST) at 1 year. The median age was 69 years (IQR, 62-78 years). Acute coronary syndrome (ACS) was the presenting diagnosis in 117 (66.9%) patients [74 (63.2%) unstable angina, 31 (26.5%) NSTEMI, 12 (10.3%) STEMI] and stable angina (SA) was present in 58 (33.1%) patients. The median SYNTAX score was 23.0 (IQR, 18.7-32.2) in the SA group and 25.0 (IQR, 20.0-30.7) in the ACS group. During 1-year follow-up in the SA group two (3.4%) MACCE occurred, both of them were cardiac deaths. In ACS patients there were 19 (16.2%) MACCE [9 (7.7%) cardiac deaths, 11 (9.4%) MIs, 11(9.4%) TLR, 1(0.9%) stroke]. Altogether, three (1.7%) cases of acute ST were noted, all of them in ACS subset. LM PCI using self-apposing Stentys DES showed favorable clinical outcomes at 1-year in patients with SA. Events of ST in the ACS group warrant further research.

An Unusual Case of Acute Stent Thrombosis: A Review of a Rare Cause of Acute Stent Occlusion

An Unusual Case of Acute Stent Thrombosis: A Review of a Rare Cause of Acute Stent Occlusion

Initial Single Centre Experience of a Novel Polymer-free Drug Eluting Stent (DES) (Cre-8) in a Real World All-Comer Patient Population

Cre-8 is a carbofilm coated cobalt-chromium amphilimus (sirolimus + organic acid) eluting stent using polymer free abluminal reservoir technology, configuration allowing increased sirolimus cellular dosing. We examined the efficacy, deliverability, deployability of Cre-8, 30- and 60-day MACCE (death, stroke, bleeding events, TLR, and rehospitalisation) in treated all-comer patients 52 consecutive patients were treated with Cre-8 stent over a 5-month period (November 2016 to March 2017) (71 vessels and 80 lesions: 50% were ACC/AHA type C, 16.3% were CTO), over half with ACS presentation (55.8%). All received dual antiplatelets and heparin. Patients had either single (n = 37, 71.2%) or multi-vessel stenting (double: 21.2%, triple 7.7%) (65 vessels stented, 6 ballooned only). 81 Cre-8 stents were deployed. Reference vessel size (mean) was 3.5 mm, longest stented length was 120 mm (mean length 30 mm). Procedural success was 100% with all stents being delivered and deployed. 1 case of acute stent thrombosis (ST) occurred due to patient factors (inadequate antiplatelet loading, antiphospholipid syndrome) and inadequate stent sizing (confirmed by IVUS). Post-dilatation performed (100%) with post-dilatation balloon greater than (74.1%) or equal to stent diameter (25.9%). Apart from 1 acute ST, all patients had no MACCE at 1 month (100%) and 2 months follow-up (73.1%). Cre-8 is safe and efficacious in our initial experience. Excellent deliverability and visibility with stent-edge markers were helpful in stent positioning. Large clinical trials are currently underway directly comparing efficacy with current DES. More data is needed.

Intracoronary vs intravenous bivalirudin bolus in ST-elevation myocardial infarction patients treated with primary angioplasty.

Intracoronary bolus administration may provide high local bivalirudin concentration without changing the global dose, potentially offering a more favorable antithrombotic effect in the infarct related artery (IRA). The purpose of this study was to investigate the feasibility and safety of intracoronary bolus administration of bivalirudin followed by the standard intravenous infusion in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). In 245 consecutive patients treated with primary PCI, bivalirudin bolus was given directly in the IRA, followed by a standard intravenous infusion. Clinical reperfusion markers, postprocedural coronary flow indexes, and bleeding events of the intracoronary group were compared with a propensity score-matched cohort of primary PCI patients (n=245) treated with the standard bivalirudin protocol of intravenous bolus and infusion. Higher rates of ⩾70% ST-segment resolution (72.7% vs 60.0%, p=0.004), lower postprocedural peak CK-MB levels (188.3±148.7 vs 242.1±208.1 IU/dl, p=0.025) and better Thrombolysis in Myocardial Infarction (TIMI) frame count values (14.7 vs 17.9, p=0.001) were observed in the IC bolus group compared with the standard intravenous bolus group. Rates of bleeding were similar between groups. Only three cases of acute stent thrombosis were observed, all in the intravenous bolus group (p=0.25). Intracoronary bivalirudin bolus administration during primary PCI is safe and improves ST-segment resolution, postprocedural coronary flow and enzymatic infarct size compared with the standard intravenous route.

Endovascular treatment of intracranial aneurysms with flow-diverter stents: preliminary single-centre experience

This paper reports our preliminary experience with the endovascular treatment of intracranial aneurysms using flow-diverter stents (FDs) and compares it with the literature data. From May 2009 to April 2012, 28 patients (6 men and 22 women; mean age, 54 years) with a total of 35 aneurysms were treated with FDs. We evaluated postprocedural technical success and long-term efficacy, with follow-up examinations performed at 3-7 days [computed tomography (CT)/magnetic resonance (MR) angiography] and at 3, 6 and 12 months (digital subtraction angiography, DSA). A total of 43 FDs were placed, 36 Pipeline and 7 Silk. A total of 30 procedures were performed (two patients were treated twice). Technical success was 96.6%, with one case of postprocedural death; the aneurysm exclusion rate at 3, 6 and 12 months was 60%, 73% and 89%, respectively. There was no case of acute stent thrombosis, and only two cases of nonsignificant stenosis. All covered side branches were patent, except one case of steno-occlusion of the ophthalmic artery. Our results are consistent with the literature and demonstrate the effectiveness and safety of FDs in selected cases of cerebral aneurysm (wide neck, fusiform, blister-like).

Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30days follow up, but no clinical events at 6 months follow up. In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

Acute carotid stent thrombosis: a case of surgical revascularization and review of treatment options

Carotid artery stenting is considered to be an alternative to carotid endarterectomy for selected patients by many vascular specialists around the world. Acute stent thrombosis following the procedure, although very infrequent, can risk the survival of the patient. In this report, we present a case of acute stent thrombosis 24 hours following the procedure. After a slow deterioration of the clinical state of the patient, he was urgently subjected to thrombectomy with extraction of the stent, with eventual resolution of his symptoms. A review of the current literature is presented together with all the possible treatment options of this serious complication. In conclusion, several neurorescue procedures are available for the vascular surgeon who has to act urgently and, in some cases, aggressively, when stent thrombosis is diagnosed.

経皮的冠動脈インターベンション直後に急性ステント血栓症を来したヘパリン起因性血小板減少症の1例

経皮的冠動脈インターベンション直後に急性ステント血栓症を来したヘパリン起因性血小板減少症の1例

Acute Coronary Stent Thrombosis in Cancer Patients: A Case Series Report

There have been a growing numbers of patients diagnosed with malignancy and coronary artery disease simultaneously or serially. In the era of percutaneous coronary intervention (PCI), stent thrombosis has been a rare but challenging problem. Recently, we experienced two unique cases of acute stent thrombosis in patients with malignancy. The first case showed acute and subacute stent thrombosis after PCI. The second case revealed simultaneous thromboses in stent and non-treated native coronary artery. We believe that we need rigorous precautions in the treatment of patients with coronary artery disease and malignancy, especially with regards to deciding how and whether to revascularize, as well as which anti-platelet agents to select.

A Case of Acute Stent Thrombosis During Treatment with the Thrombopoietin Receptor Agonist Peptide—Romiplostim

Romiplostim is a thrombopoietin receptor agonist that increases platelet counts and restores platelet function in patients with chronic immune thrombocytopenia (ITP). Increase in platelet count and platelet activation has been associated with increased thromboembolic risk. The present case report describes an interesting case of acute stent thrombosis in a patient with chronic immune thrombocytopenic purpura (ITP) being treated with romiplostim.

Acute stent thrombosis during percutaneous coronary intervention

Although rarely reported, acute instent thrombosis can be life threatening, especially in cases where there are no ST segment changes. For this reason, careful history taking, follow-up, and prompt coronary angiography may be lifesaving. Herein, a case of acute stent thrombosis with no ST segment changes on electrocardiogram that was resolved with intracoronary tirofiban is presented.

Acute Multi-Vessel Coronary Stent Thrombosis

Coronary artery stent thrombosis is a rare but often fatal complication associated with percutaneous coronary intervention (PCI) using both bare-metal stents and drug-eluting stents. Although strict adherence to dual anti-platelet therapy (aspirin plus clopidogrel) minimizes this risk, stent thrombosis will still occur in rare patients, leading to acute, subacute, or late life-threatening acute coronary syndromes. To present a rare case of acute stent thrombosis involving multiple vessels to increase awareness of this life-threatening condition among emergency physicians, and to review the current guidelines for anti-platelet therapy in this patient population. A 52-year-old man who underwent PCI using drug-eluting stents in two separate coronary vessels presented to the Emergency Department within 2 h of discharge from the hospital with chest pain, dynamic electrocardiogram changes, and elevated cardiac markers. Despite compliance with the current recommendations for post-PCI anti-platelet therapy, urgent repeat catheterization revealed total thrombotic occlusion of both stents, requiring urgent repeat intervention. Despite patient compliance with the currently recommended anti-platelet regimen after stent therapy for coronary artery disease, acute stent thrombosis remains a rare but life-threatening risk in both the immediate and delayed post-intervention period. In addition, premature cessation of this anti-platelet therapy stands as the greatest risk factor for such thrombotic events. This case is presented to inform emergency physicians of the current post-PCI anticoagulation recommendations to help mitigate the risk of such complications.

Protamine usage following implantation of drug‐eluting stents: A word of caution

The treatment of hemorrhagic complications of percutaneous interventions with protamine is an accepted practice. Concerns exist about the increased thrombo-genicity of drug-eluting stents. We report two cases of acute stent thrombosis following drug-eluting stent implantation related to protamine administration.

Clinical and Angiographic Outcomes After Placement of Multiple Overlapping Drug-Eluting Stents in Diffuse Coronary Lesions

Multiple overlapping drug-eluting stents have increasingly been used to treat diffuse coronary disease, but the safety and efficacy of this approach remains unclear. We assayed the clinical and angiographic outcomes after placement of "full metal jacket" stents (stented length >or=60 mm) in 347 consecutive patients (352 lesions) with very long de novo coronary lesions. Mean age was 61.0 +/- 10.1 years, and the mean stented length was 71.9 +/- 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (1 death, 2 cases of acute stent thrombosis) occurred in 3 patients (0.7%). Angiographic follow-up data, obtained for 230 (234 lesions) of the 328 eligible patients (70.1%), showed that the restenosis rate was 13.7%. Multivariate analysis found that the reference artery diameter (odds ratio 0.05, 95% confidence interval [CI] 0.01 to 0.33, p = 0.002) and the use of Taxus stents (odds ratio 2.88, 95% CI 1.03 to 8.04, p = 0.043) were significant predictors of restenosis. During follow-up (16.6 +/- 6.9 months), 9 deaths (6 cardiac and 3 noncardiac), 1 nonfatal myocardial infarction, and 13 target lesion revascularizations occurred. The cumulative probability of survival without major adverse cardiac events (cardiac death, Q-wave myocardial infarction, and target lesion revascularization) was 95.4 +/- 1.1% and 91.4 +/- 2.1% at 1 and 2 years, respectively. Left ventricular dysfunction (ejection fraction <45%) was the only predictor of stent thrombosis (hazard ratio 18.24, 95% CI 1.65 to 201.19, p = 0.018) and cardiac death/Q-wave myocardial infarction (hazard ratio 5.37, 95% CI 1.28 to 22.49, p = 0.021). In conclusion, full metal jacket drug-eluting stents may be a safe and effective method to treat diffuse coronary disease and may be a useful treatment option for complex long lesions.

Clinical Experiences of Coronary MAC (Maximum Arterial Re-Creation) Stent

Background and Objectives:We previously reported the effects of MAC (Maximum Arterial Re-Creation stent on stent restenosis in a porcine model. The clinical trial was performed in patients with ischemic heart disease after MAC stent implantation. Materials and Method:We analyzed the clinical and angiographic re-sults in 20 patients in 22 lesions (15 M, 5 F, 59±11 year, who underwent MAC stent at Chonnam University Hospital between Nov ' 97 and Aug ' 98. Clinical diagnosis was 13 unstable angina (65%, 6 acute myocardial infarction (30% and 1 old myocardial infarction (5%. Results:Indications for stent were 3 de novo lesion (13.6%, 7 restenosis (31.8%, 8 suboptimal angioplasty result (36.4% and 4 bail-out procedure (18.2%. Target stented coronary arteries were 15 left anterior descending coronary arteries (67.3%, 2 left circumf- lex coronary arteries (9.1% and 5 right coronary arteries (22.7%. Morphologic types were 13 type B1 (59.1%, 5 B2 (22.7% and 4 C (18.2%. Minimal luminal diameter (MLD before stent was 0.75±0.35 mm and percent dia- meter stenosis (DS was 75±11.5%, which were improved 2.97±0.28 mm in MLD and 2.79±5.4% in DS after stent. MAC stent was placed successfully in all patients and one case of acute stent thrombosis was improved after ReoPro infusion. Mean follow-up period was 5.2±3.2 months and 100% event-free survival was observed in all patients. Follow-up coronary angiography was performed in 5 patients and showed no stent restenosis. Conclusion:The MAC stent is one of effective and safe devices in the treatment of coronary artery diseases witho- ut significant complications and target vessel revascularization. (Korean Circulation J 1998;28(10 :1700-1706 KEY WORD:MAC (Maximum Arterial Re-Creation stent.