Zhang Weifeng, Jia Shengqi, Wu Yanmin, Jia Haiyan
Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China.
Department of Cardiology, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin, China.
Front Cardiovasc Med. 2025 Jul 10;12:1637979. doi: 10.3389/fcvm.2025.1637979. eCollection 2025.
Acute stent thrombosis (AST) is a rare but serious complication occurring within 24 h after percutaneous coronary intervention (PCI), typically caused by insufficient antiplatelet therapy, stent under-expansion, or malapposition. Tissue prolapse (TP) within the stent is less frequently reported as a cause of AST and lacks direct imaging-based evidence.
We report a case of a patient with acute ST-segment elevation myocardial infarction (STEMI) who experienced recurrent ST-segment elevation 1 h after primary PCI. Coronary angiography revealed mid-stent occlusion, and intravascular ultrasound (IVUS) identified tissue prolapse with echogenic features consistent with fibrolipidic plaque. The initial stent was appropriately sized and well-deployed, and activated clotting time (ACT) indicated adequate anticoagulation. In the absence of traditional risk factors for AST, the large-volume tissue prolapse was considered the likely cause. Balloon angioplasty failed to resolve the prolapse, so an additional stent was implanted at the site. After this intervention, no further thrombotic events occurred.
This case provides clear intravascular imaging evidence that tissue prolapse can induce AST. For cases of early stent thrombosis with angiographic haziness and no signs of dissection or malapposition, clinicians should suspect tissue prolapse. Intravascular imaging facilitates accurate diagnosis and helps guide treatment. Further research is warranted to define high-risk features of tissue prolapse-such as volume, protrusion, and composition-to establish thresholds and interventional criteria that may prevent AST.
急性支架血栓形成（AST）是经皮冠状动脉介入治疗（PCI）后24小时内发生的一种罕见但严重的并发症，通常由抗血小板治疗不足、支架扩张不全或贴壁不良引起。支架内组织脱垂（TP）作为AST的病因较少被报道，且缺乏基于直接成像的证据。
我们报告一例急性ST段抬高型心肌梗死（STEMI）患者，在初次PCI后1小时出现反复ST段抬高。冠状动脉造影显示支架中段闭塞，血管内超声（IVUS）识别出组织脱垂，其回声特征与纤维脂质斑块一致。初始支架尺寸合适且展开良好，活化凝血时间（ACT）表明抗凝充分。在没有AST传统危险因素的情况下，大量组织脱垂被认为是可能的原因。球囊血管成形术未能解决脱垂问题，因此在该部位植入了一枚额外的支架。此次干预后，未再发生血栓事件。
本病例提供了明确的血管内成像证据，表明组织脱垂可诱发AST。对于早期支架血栓形成且血管造影模糊且无夹层或贴壁不良迹象的病例，临床医生应怀疑组织脱垂。血管内成像有助于准确诊断并指导治疗。有必要进行进一步研究以确定组织脱垂的高危特征，如体积、突出程度和成分，以建立可能预防AST的阈值和介入标准。
