Cangrelor Bridge for Repeat Cesarean After Third Trimester Percutaneous Coronary Intervention for Total Occlusion NSTEMI.

Acute coronary syndrome is an uncommon but potentially life-threatening complication in pregnancy, and dual antiplatelet therapy presents challenges in patients requiring cesarean delivery. We present a 39 year-old woman who presented at 29 weeks gestation with a non-ST segment myocardial infarction (NSTEMI). Urgent coronary angiogram revealed 100% occlusion of the left anterior descending coronary artery. She underwent percutaneous coronary intervention (PCI) with one drug-eluting stent and was initiated on dual antiplatelet therapy. Due to prior classical cesarean delivery, she required repeat cesarean less than 3 months from PCI. Cangrelor was used as bridging therapy prior to cesarean delivery at 37 weeks gestation to balance the thrombotic and bleeding risks. This case underscores the importance of recognizing total coronary occlusion in NSTEMI presentations and is, to our knowledge, the first reported use of intravenous cangrelor as perioperative bridging therapy for cesarean delivery in a pregnant patient with recent PCI for acute coronary syndrome.