case_images: PMC4369974_01
case_images: Coronary angiography shows simultaneous stent thrombosis on LAD and OM1 (a) and restoration of good flow after thrombus aspiration, GPIIbIIIa inhibitor infusion and dilation with a semi-compliant balloon (b; yellow arrowheads highlight stent edges). Coronary angiography after 4 days of heparin infusion showed reasonable good results on both LAD and OM1 (c and d). IVUS showed well-stent strut apposition (red arrowheads; e, f, h and i) in both vessels with residual thrombotic material (pink area; f and i), causing a significant reduced minimal lumen area on OM1 (i).
case_images: omu06301.jpg
case_images: PMC4369974_01_omu06301.jpg
case_images: OMU063F1
case_images: Immediate coronary angiogram demonstrated simultaneous recurrent stent thrombosis of both LAD and OM1 stents (Fig. 1a). However, residual haziness was noted within both stents (Fig. 1b). After 4 days of intravenous heparin infusion, a repeat angiogram (Fig. 1c and d) with fractional flow reserve (FFR) and intravascular ultrasound (IVUS; Fig. 1e-g) was performed. Results were satisfactory in the LAD with an FFR of 0.84 (thus excluding significant residual ischaemic burden) and well-apposed stents were visualized in both LAD and OM1 using IVUS (Fig. 1 e, f, h and i). Fig. 1i). Further dilation to the stent in OM1 was then performed with a 3.5 x 15 mm non-compliant balloon with reasonable final results. 