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Stent Thrombosis — EECC MCQ

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ModerateCoronary Artery DiseaseStent ThrombosisEECC

A 52-year-old man who underwent PCI with a drug-eluting stent to the LAD 3 days ago presents with acute ST elevation in V1-V4 and cardiogenic shock. Emergency angiography shows occlusion at the stent site with thrombus. What is the most likely diagnosis?

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Correct answer: A — Subacute stent thrombosis

Stent thrombosis is classified by timing: acute (<24 hours), subacute (1-30 days), late (1-12 months), and very late (>12 months). This presentation at day 3 with acute occlusion and thrombus is subacute stent thrombosis, a catastrophic complication with 20-40% mortality. Causes include premature antiplatelet discontinuation, stent malapposition, underexpansion, and clopidogrel resistance. Treatment is emergency PCI with aspiration thrombectomy and assessment of stent deployment adequacy with intravascular imaging. DAPT adherence and P2Y12 inhibitor choice should be reviewed.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes