Thrombocytosis as a potential cause of a very late stent thrombosis in the left main coronary artery.

A 36 year-old man, who had undergone a paclitaxel-eluting stent deployment into the left main (LM) coronary artery three years before, was admitted after successful resuscitation following out-of-hospital cardiac arrest due to an acute ST-segment elevation myocardial infarction. Six weeks before the admission, he had discontinued clopidogrel. Coronary angiography showed a total occlusion of the LM artery. A complex percutaneous coronary intervention including thrombectomy and a second everolimus-eluting stent deployment in the LM artery and the left descending coronary artery was performed; this resulted in the restoration of TIMI 2/3 flow. A detailed investigation revealed an essential thrombocytosis necessitating treatment with hydroxyurea and indefinite dual antiplatelet therapy.