[Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion]

Abstract

A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized.

Keywords: Acute stent thrombosis; Cardiopatía isquémica; Dilatación transitoria ventricular inversa; Ischemic heart disease; Myocardial perfusion; Perfusión miocárdica; Single-photon emission computed tomography; Tomografía computarizada de emisión monofotónica; Transient reverse ventricular dilation; Trombosis aguda stent.