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Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound

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Abstract

Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, which had been implanted in the right coronary artery 3 years earlier, did not show such a finding. IVUS revealed “different vascular reactions” to “different types of DES” in this patient.

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Authors and Affiliations

  1. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan

    Masahiro Yamawaki, Masatsugu Nakano, Hiroshi Ishimori, Keisuke Hirano, Yoshiaki Ito, Reiko Tsukahara & Toshiya Muramatsu

  2. Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands

    Yoshinobu Onuma, Takashi Muramatsu, Shimpei Nakatani & Yuki Ishibashi

Authors
  1. Masahiro Yamawaki
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  2. Yoshinobu Onuma
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  3. Masatsugu Nakano
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  4. Takashi Muramatsu
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  5. Shimpei Nakatani
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  6. Yuki Ishibashi
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  7. Hiroshi Ishimori
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  8. Keisuke Hirano
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  9. Yoshiaki Ito
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  10. Reiko Tsukahara
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  11. Toshiya Muramatsu
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Correspondence to Masahiro Yamawaki.

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Yamawaki, M., Onuma, Y., Nakano, M. et al. Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound. Heart Vessels 30, 824–829 (2015). https://doi.org/10.1007/s00380-014-0545-0

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  • DOI: https://doi.org/10.1007/s00380-014-0545-0

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