A Case Report of Recurrent Subacute Stent Thrombosis After Drug Eluting Stent Implantation: What Is the Real Reason?

A 63-year-old male was admitted with subacute anterior ST-elevation myocardial infarction. Cardiac catheterization revealed a subtotal occlusion in the proximal and middle part of left anterior descending coronary artery. Subacute stent thrombosis (SAT) occurred recurrently until the last stent deployment solved the problem of the uncovered artery and distal-stent edge dissection. The patient's SYNTAX score was 19, and percutaneous coronary intervention (PCI) was performed. Unfortunately, SAT occurred recurrently after drug eluting stent implantation. What reason should be responsible for the recurrent SAT, clopidogrel hyporesponse or mechanical factors? All anti-platelet therapy has been tried, but adenosine diphosphate (ADP)-induced platelet aggregation remained hyporesponsive to clopidogrel. The patient has been symptom-free at follow-ups since the fourth PCI solved the problem of the uncovered artery and distal-stent edge dissection.