We report a case of late stent thrombosis in the immediate postoperative period of non-cardiac surgery four weeks after a bare metal stent(BMS) implantation. A 77-year old man who was scheduled for thoracoscopic mediastinal lymph node biopsy received preoperatively implantation of BMS for significant stenosis in the proximal left anterior descending coronary artery. The surgery was postponed four weeks after the stent insertion and the dual anti-platelet therapy with aspirin and ticropidine was discontinued one week before the surgery. The surgery was successfully performed under general anesthesia even with episodes of bradycardia and hypotension.
Immediately after the surgery, ST-segment elevation in left precordial leads and acute heart failure appeared following a complete atrioventricular block. An emergency coronary angiogram revealed a thrombotic stenosis of the BMS and a restenting restored the stent patency and its hemodynamics.
In this case, one of the most important factors causing the stent thrombosis must be discontinuation of antiplatelets. It is very difficult to decide whether to continue antiplatelets or not, because the risk of bleeding or stent thrombosis depends on the type of surgery, stent, and antiplatelets and the time between the stenting and the surgery. Therefore, the issues as stated above should be discussed cautiously among the anesthesiologist, surgeon, and treatment physician.
