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.
Keywords
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References
- Very late thrombosis in a bare metal stent: Mechanistic analysis from optical coherence tomography.Catheter Cardiovasc Interv. 2012; 79 (Epub 2011 Jun 6): 288-290https://doi.org/10.1002/ccd.23024
- Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period.Eur Heart J. 2009; 30: 2714
- Pathological mechanisms of fatal late coronary stent thrombosis in humans.Circulation. 2003; 108 (Epub 2003 Sep 22): 1701-1706
Article info
Publication history
Published online: December 26, 2014
Accepted:
November 26,
2014
Received in revised form:
November 22,
2014
Received:
October 18,
2014
Identification
Copyright
© 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
