Synergistic mechanism of coincidence of two subacute stent thromboses: Insights from multiple imaging observations.

In the drug-eluting stent era, stent thrombosis is uncommon but still a life-threatening complication after percutaneous coronary intervention. There are several types of risk factors associated with stent thrombosis, which could work synergistically to produce thrombus. We report the case of subacute stent thrombosis. A 66-year-old male was hospitalized due to ST-segment elevation myocardial infarction and received emergency percutaneous coronary intervention to the obtuse marginal branch and the posterolateral artery. Five days later, he complained of chest pain. Emergency coronary angiography was performed and revealed stent thromboses in both the obtuse marginal branch and the posterolateral artery. Remarkably, in this case, stent thromboses occurred in the obtuse marginal branch and the posterolateral artery simultaneously. Finally, we overcame this situation by stenting to the main branch of left circumflex artery. We speculated the precise mechanism of simultaneously occurring two subacute stent thromboses through multiple intracoronary imaging modalities. In this case, we hypothesized that the combination of the protrusion of obtuse marginal branch stent to the main branch of left circumflex artery, blood flow turbulence due to the ulcer, and relatively high thrombogenicity of acute coronary syndrome lesion synergistically generated the thrombus. <Learning objective: Stent thrombosis following percutaneous coronary intervention is known as a life-threatening complication. To deal with this fatal complication appropriately, we should know the etiology of stent thrombosis. In this case, we revealed the effect of synergistic mechanism by enhanced thrombogenicity, malapposed struts, and blood flow turbulence by using multiple imaging modalities. Thus, we could decide to deploy the stent to the ulcer-like lesion of the main branch of the left circumflex artery.>.