CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 April;178(4):238-43

DOI: 10.23736/S0393-3660.18.03770-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Secondary or primary percutaneous coronary interventions

Ramin KHAMENEH BAGHERI ^{1, 2}, Mostafa AHMADI ^{1, 2} ✉, Faeze KEIHANIAN ^{1, 2, 3}

¹ Department of Cardiology, Imam Reza Hospital, Mashhad, Iran; ² Faculty of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; ³ Division of Pharmaceutical Research, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Thrombus formation in an implanted stent of a coronary artery can lead to sudden occlusion of the artery. Stenting across the coronary ostium can stabilize the smaller aortocoronary dissections, yet, extension of the coronary dissection more than 40 mm to the aorta usually requires surgical treatment. The case presented here was an Iranian Persian ethnicity 80-year-old male with acute anterolateral ST-Segment Elevation Myocardial Infarction (STEMI). He had a history of extensive anterior STEMI and primary Percutaneous Coronary Interventions (PCI) on the Left Anterior Descending (LAD) and diagonal arteries (double stenting technique). The emergent coronary angiogram showed thrombotic occlusion of the diagonal artery’s stent, although the LAD stent was patent. The diagonal stent had been inserted in the LAD artery about 2 to 3 mm, with limited expansion. This under-expanded and non-apposed segment of the stent was a strong risk factor for stent thrombosis. After completion of the intervention and restoration of the diagonal artery flow, the guiding catheter movement accidentally induced dissection of the Left Main Coronary Artery (LMCA), which was retrograde extended to the aorta. Therefore, deployment of a stent at the coronary ostium was used and the complication was managed successfully. Aortocoronary dissection is a rare, yet dangerous complication related to coronary intervention, and small and localized forms can be managed by an endovascular approach.

KEY WORDS: Stents - Thrombosis - Percutaneous coronary intervention