Sidi M'hamed Ely, Jérôme Taïb, Taleb Issa Mohamed Lemine, Ould Cheikhna Youssef
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 10
Date of Publication: 2026/10/11
Abstract
Introduction: Stent thrombosis is a rare but serious complication of percutaneous coronary
intervention (PCI), with high morbidity and mortality. Recurrence in several coronary
territories in the same patient is exceptional and raises questions about predisposing factors and
antithrombotic strategy, especially in patients with atrial fibrillation (AF) who require oral
anticoagulation.
Case presentation: We report the case of a 69-year-old man with known coronary artery
disease (right coronary artery stent in 2016), former smoker and cannabis user, with
dyslipidaemia and paroxysmal AF on rivaroxaban. Eight weeks before admission, he had an
inferobasal myocardial infarction due to thrombotic occlusion of the right coronary artery at the
site of the old stent (very late stent thrombosis), complicated by an electrical storm and treated
with stent-in-stent implantation. Ten days before admission, a drug-eluting stent was implanted
in the mid left anterior descending artery (LAD). He was admitted for an extensive anterior ST
segment elevation myocardial infarction while on triple antithrombotic therapy (aspirin,
clopidogrel, rivaroxaban), with no reported interruption. Coronary angiography showed
thrombotic in-stent occlusion of the mid LAD (TIMI 0 flow), treated with balloon angioplasty
and intracoronary tenecteplase, with final TIMI 2 flow. The course was complicated by left
ventricular failure (ejection fraction falling from 51% to 25%) and right-sided pneumonia.
Because of a suspected apical thrombus, rivaroxaban was replaced by acenocoumarol, and he
was discharged on one month of triple antithrombotic therapy (aspirin, clopidogrel,
acenocoumarol) and full heart failure therapy.
Conclusion: This case illustrates the multifactorial nature of stent thrombosis: maximal
antithrombotic protection (triple therapy) does not eliminate the risk. Recurrent stent
thrombosis despite well-conducted treatment should prompt intravascular imaging to identify
mechanical causes, consideration of poor response to antiplatelet agents and thrombophilia, and
adjustment of antithrombotic intensity.
stent thrombosis; acute coronary syndrome; atrial fibrillation; oral anticoagulants; triple antithrombotic therapy; percutaneous coronary intervention
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