Author + information
- Received April 3, 2012
- Revision received May 21, 2012
- Accepted June 21, 2012
- Published online December 1, 2012.
- Helen Curran, MD,
- Kensuke Takagi, MD,
- Alaide Chieffo, MD,
- Chiara Foglieni, MD,
- Azeem Latib, MD,
- Matteo Montorfano, MD,
- Chiara Bernelli, MD,
- Gill Louise Buchanan, MBChB,
- Irene Franzoni, MD and
- Antonio Colombo, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus Hospital, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
Percutaneous coronary intervention for acute myocardial infarction carries the risk of distal embolization (1). The MGuard (InspireMD, Tel Aviv, Israel) is a mesh-covered bare-metal stent developed as a plaque-trapping device to treat thrombotic lesions (Fig. 1).
A 60-year-old man presented with ST-segment elevation myocardial infarction due to very late in-stent thrombosis of a left anterior descending artery stent. Percutaneous coronary intervention was performed with a 3.0 × 12 mm MGuard stent, resulting in jailing and occlusion of the diagonal. Re-crossing was difficult but eventually achieved, allowing dilation and final kissing balloon technique (Fig. 2A).
Three days later the patient developed recurrent stent thrombosis (Fig. 2B), and a large thrombus was aspirated from the left anterior descending artery (Fig. 2C). Intravascular ultrasound (IVUS) visualized stent under-expansion (Fig. 2D) and mobile echogenic material on stent struts at the diagonal ostium (Fig. 2E). The stent was dilated, and final IVUS confirmed adequate stent expansion (Fig. 2F). Pathological assessment of thrombus detected the presence of stent constituents (metal or mesh) (Figs. 3A to 3D).
We speculate the etiology of stent thrombosis was multifactorial from stent under-expansion and disruption of MGuard stent integrity (from re-crossing and diagonal dilation) as supported by IVUS and pathological findings.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 3, 2012.
- Revision received May 21, 2012.
- Accepted June 21, 2012.
- American College of Cardiology Foundation