PMC8736693_01
Coronary angiography and LAD primary PCI. Thrombotic occlusion at the site of the proximal LAD stent with TIMI 0 flow (A, B, arrow) and evidence of thrombus at the site of the proximal LCX stent (A, B, arrow) and the mid RCA stent (C, arrows). Following PCI and restoration of TIMI 3 flow in the LAD, there was evidence of remaining thrombus at the site of proximal LCX stent (D, arrow). Resolution of thrombus at the site of the proximal LCX stent (E, arrow) and the mid RCA stent (F, arrow) on day 3 of admission. LAD: left anterior descending artery; LCX: left circumflex artery; RCA: right coronary artery; PCI: percutaneous coronary intervention.
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PMC8736693_01_CRIC2021-2658094.001.jpg
fig1
Emergency cardiac catheterization revealed 100% occlusion of proximal to mid LAD with instent thrombosis, and 90% stenosis in proximal LCX and mid RCA stents (Figure 1(a)-1(c)). TIMI-3 flow to distal LAD was restored, a Synergy 3.0 x 24 mm DES was then placed and post dilated with a 3.5 mm non-compliant balloon (Figure 1(d) ). The patient was hemodynamically stable and brought back to catheterization laboratory 2 days later for staged PCI of LCX and RCA lesions. However, angiography showed that previously found severe stenosis in the above vessels was no longer visualized (Figure 1(e) and 1(f)), it turned out that previously noted instent stenosis was actually caused by thrombus at the time of acute STEMI and had dissolved spontaneously over time.