Perioperative very late stent thrombosis treated with thrombosuction.

Fig. 1: Left coronary angiogram in Right Anterior Oblique view with caudal tilt showing thrombus inside the Left Anterior Descending ( LAD) stent at diagonal origin .Note the haziness marked by arrow , indicating a filling defect inside the stent . LCX= Left circumflex , LMCA= Left Main Coronary Artery ,OM = Obtuse Marginal. Fig. 2: Post thrombosuction left coronary angiogram in the same view shows that the filling defect has disappeared. Abbreviations are as in the previous figure. INTRODUCTION With widespread use of Drug Eluting Stents (DES), perioperative dual antiplatelet issues are becoming more frequent. The risk of perioperative bleeding needs to be balanced against the devastating complication of stent thrombosis since mortality rates for stent thrombosis range from 20% to 45%. Usually these issues are a concern within the first year after stent implantation . We report a case where perioperative withdrawl of dual antiplatelets prior to a non-cardiac surgery lead to stent thrombosis and cardiogenic shock, five years post implantation .