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J Thorac Cardiovasc Surg 2003;125:1544-1546
© 2003 The American Association for Thoracic Surgery

Brief Communications

Acute stent thrombosis after off-pump coronary bypass surgery: A new and avoidable complication?

J. M. Alvarez, FRACSa, L. Chen, MB, BSa, I. N. Sinclair, FRACPb Perth, West Australia

From the Departments of Cardiothoracic Surgery and Cardiology, Sir Charles Gairdner Hospital, Perth, West Australia.

Received for publication July 15, 2002. Accepted for publication Oct 10, 2002. Address for reprints: J. M. Alvarez, FRACS, Department of Cardiothoracic Surgery, Verdun St, Nedlands, Perth, West Australia 6009 (E-mail: John.Alvarez@health.wa.gov.au).

The first 20% of the full text of this article appears below.

A majority of percutaneous revascularization procedures incorporate percutaneous transluminal coronary artery stenting with balloon percutaneous transluminal coronary angioplasty (PTCA). Acute coronary stent thrombosis, however, remains an uncommon yet serious complication.Go 1 Recently, off-pump coronary artery bypass (OPCAB) surgery has gained widespread popularity.Go 2 However, the effect of OPCAB surgery on coagulation-fibrinolytic homeostasis is unclear. We report 2 cases of acute coronary stent thrombosis in previously stented ungrafted coronary arteries (ie, angiographically normal) after OPCAB surgery. Both patients had normal coagulation profiles.

Clinical summaries

PATIENT 1. A 42-year-old male smoker was admitted with unstable angina. The patient's sole previous history was of successful primary right coronary artery (RCA) PTCA after an inferior acute myocardial infarction (AMI) in 1995. Despite treatment with aspirin and intravenous heparin and glyceryl trinitrate, angina persisted; cardiac catheterization revealed a 90% discrete (19 mm) RCA stenosis and a total left anterior descending coronary artery (LAD) occlusion, and left ventricular function was normal. A 35 x 8-mm Tetra stent was successfully deployed to the RCA, and daily clopidogrel was added (Figure 1, A and B).


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