The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Peri-procedural stent thrombosis following bifurcational PCI of lipid-rich plaque: serial optical coherence tomography insights

DOI: 10.4244/EIJ-D-20-00731

1. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland, Switzerland

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.

Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.

To read the full content of this article, please log in to download the PDF.

Pre-procedural optical coherence tomography (OCT) of the left anterior descending artery (LAD) in a 58-year-old man with unstable angina due to a stenosis involving LAD and first diagonal branch detected underlying mixed plaque, partially containing lipid in a circumferential distribution distal to the first diagonal branch (Figures A1-3). Bifurcational percutaneous coronary intervention with side-branch-stenting (double-kissing mini-crush: 2.0x18mm zotarolimus-eluting-stent (ZES) in diagonal branch, 2.25x38mm-ZES in LAD with post-dilation using 3.0x20mm and 3.5x8mm non-compliant balloons) was performed after loading with ticagrelor (180mg) and cumulative administration of 15’000 IU of heparin to achieve an activated clotting time >250 seconds. At the end of the procedure, acute stent thrombosis (ST) occurred in the LAD-stent distal to the bifurcation (Figures B1-3). OCT excluded underexpansion or malapposition as possible causes for ST, but showed fresh thrombus on top of protruding signal-rich tissue suggestive of atheromatous material at the site of maximal pre-procedural lipid-burden (Figure B1).

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

Read next article
Brachial Arterial Access for PCI: an Analysis of the British Cardiovascular Intervention Society Database