Mechanism of Drug-Eluting Stent Thrombosis Diagnosed by Histopathological Evaluation of Directional Coronary Atherectomy Specimen

Kazuki Ito; Shinya Fujita; Atsushi Sakamoto; Hayato Ohtani; Masahiro Muto; Yuichiro Maekawa

doi:10.1016/j.jaccas.2023.102123

Mechanism of Drug-Eluting Stent Thrombosis Diagnosed by Histopathological Evaluation of Directional Coronary Atherectomy Specimen

JACC Case Rep. 2023 Nov 14:28:102123. doi: 10.1016/j.jaccas.2023.102123. eCollection 2023 Dec 20.

Authors

Kazuki Ito¹, Shinya Fujita¹, Atsushi Sakamoto², Hayato Ohtani², Masahiro Muto¹, Yuichiro Maekawa²

Affiliations

¹ Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Japan.
² Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.

Abstract

An 89-year-old man with a history of percutaneous coronary intervention using a sirolimus-eluting stent presented with recurrent in-stent occlusion. Pathological assessment of the neointima resected via directional coronary atherectomy revealed a double-layered thrombus. Clopidogrel resistance and limited antithrombotic regimen owing to high bleeding risk likely resulted in the in-stent thrombotic occlusion.

Keywords: directional coronary atherectomy; drug-eluting stent; in-stent restenosis; in-stent thrombosis.

Publication types

Case Reports