A 48 year-old man admitted for urgent follow up-coronary angiogram due to chest pain of 3-day duration.
He underwent a percutaneous coronary intervention (PCI) for the critical stenosis in the distal circumflex artery using 3.0*32 mm TAXUS stent (Fig. 1A and B) under the diagnosis of acute myocardial infarction 2 years ago. He had no chest pain after PCI. Routine follow-up coronary angiogram at 6 months after PCI showed mild type IB in-stent restenosis in the proximal portion of previously placed drug-eluting stent (Fig. 2A). He had no cardiac symptoms during clinical follow-up after initial follow-up coronary angiogram. The second routine follow-up coronary angiogram at 20 months after PCI revealed mild aneurysmal dilatation in the proximal part of stent without significant luminal narrowing (Fig. 2B). The patient had no angina after the second follow-up coronary angiogram.
The urgent diagnostic coronary angiogram revealed thrombotic total occlusion in the previously aneurysmal dilatation site of left circumflex artery (Fig 3A). After aspiration of thrombi using Thrombuster and with ReoPro infusion, 3.5*33 mm Cypher stent was deployed successfully (Fig. 3B).
Aneurysmal dilatation after drug-elutung stent implantation may be one of causes of late stent thrombosis.