A new case study demonstrates that the implantation of a Genous stent (OrbusNeich) may represent a safe and optimal treatment approach for the management of acute myocardial infarction caused by a very late stent thrombosis due to drug-eluting stent fracture. The case was published in the December issue of Catheterization and Cardiovascular Interventions.
This is the case study of a patient with non-ST elevation myocardial infarction (NSTEMI), which shows successful clinical outcomes at 12-month follow-up post Genous stent implantation after only one month of dual antiplatelet therapy (DAPT).
“Stent fracture can result in development of acute coronary syndrome and stent thrombosis due to wall injury, and these conditions may require specific attention,” said Stephen WL Lee, chief in Cardiology, Queen Mary Hospital at the University of Hong Kong. “The Genous stent possibly works in this specific setting to promote healing and enhance post stent fracture recovery. The pro-healing benefits of the Genous endothelial progenitor cell (EPC) capturing stent could be beneficial in this type of poor healing situation.”
The patient, a 49-year-old male, was diagnosed with NSTEMI and elevated Troponin-I. The angiogram revealed several occlusive thrombi within the two drug-eluting stents previously implanted in the distal right coronary artery. The stent fracture of a sirolimus eluting Cypher stent (Cordis) was diagnosed visually by angiography. After persistent thrombus formation and sub-optimal flow after thrombolectomy and balloon angioplasty, a Genous stent was implanted.
The patient had three previous coronary interventions (PCI) with a Cypher drug-eluting stent implantation in the mid right coronary artery and a second Cypher drug-eluting stent implantation in the distal right coronary artery. In a third PCI driven by ischaemia due to a new lesion, another Cypher drug-eluting stent was implanted into the distal right coronary artery overlapping with the outlet of the previous Cypher drug-eluting stent in the distal right coronary artery. Initially, the patient received DAPT for 12 months, followed by aspirin alone, and remained asymptomatic until he developed acute coronary syndrome.