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
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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).

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