Abstract
A 63-year-old man who had ST elevation myocardial infarction (STEMI) was admitted to our hospital. His coronary risk factors are hypertension and current smoking. An emergency coronary angiography (CAG) revealed total occlusion with thrombus formation in the proximal portion of left anterior descending artery (LAD) and the proximal portion of left circumflex artery (LCX). A good collateral from right coronary artery to the posterolateral branch (PL) was observed. Primary percutaneous coronary intervention (PCI) was performed with an intra-aortic balloon pump (IABP) support. Firstly, 3.5×15 mm everolimus-eluting stent (EES) implantation for LAD was performed and TIMI 3 flow was obtained. Continuously, 4.0×23 mm bare metal stent (BMS) implantation for LCX was performed and TIMI 3 flow was obtained. Dual antiplatelet therapy was started after procedure. He had no major complication after primary stenting and withdrew from IABP 4 days after initial PCI. Nine days after initial PCI, he had severe chest pain with ECG change. A emergency CAG revealed total occlusion within BMS which was implanted in LCX and no stenosis within EES in LAD. Continuously, thrombectomy and balloon angioplasty were performed for LCX and TIMI 3 flow was obtained. We report a case that both EES and BMS were implanted in the patient with STEMI and subacute stent thrombosis occurred not in the EES but in the BMS 8 days after stent implantation.
