Allergic recurrent coronary stent thrombosis: A mini-review of Kounis syndrome

Ferreira, Roberto Muniz; Villela, Paolo Blanco; Almeida, Juliano Carvalho Gomes de; Sampaio, Pedro Paulo Nogueres; Albuquerque, Felipe N.; Pinheiro, Fernanda M.C.; Filho, William França; Salles, José Ary Boechat e; Filho, João Mansur

doi:10.1016/j.carrev.2018.03.001

Cited by 13 publications

(1 citation statement)

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“…They observed evaginations around the SES and an eosinophilic infiltration in in-stent thrombi. Regarding the recurrent in-stent thrombosis observed in our patient, a similar case of KS was previously reported for whom oral prednisone and fexofenadine were given after the third episode of ST, resulting in settlement of the ST. 14 A study showed that steroids and mast cell stabilizers reduce the incidence of inflammation-induced thrombotic events. 15 In our case, antihistamine drugs were not used in accordance with the patient’s preference, and antiplatelet therapy and steroids were insufficient in controlling the recurrent in-stent thrombotic events in the acute phase.…”

Section: Discussionmentioning

confidence: 99%

A case report of Kounis syndrome presenting with a rash, very late stent thrombosis and coronary evaginations

Fujisaki

Higa

Uechi

et al. 2020

European Heart Journal - Case Reports

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Background Very late stent thrombosis (ST) is a concern in the era of drug-eluting stents (DESs), and ST is associated with peri-DES coronary artery aneurysmal lesions or coronary evaginations. An increasing number of cases of concurrent systemic allergic reaction and ST have been reported as Kounis syndrome (KS) in the literature. The number of patients with very late ST caused by KS is small, and further investigation of the potential pathophysiology is required. Case summary We report a case of KS that manifested as systemic urticaria followed by very late ST 14 years after placement of two sirolimus-eluting stents (SESs). Three months after the event of ST, coronary evaginations at the stented segments were detected on intravascular optical coherence tomography. Discussion Coronary evaginations are associated with local hypersensitivity, stent malapposition, uncovered strut, and flow disturbance that may predispose to ST. Systemic allergic reactions are known to promote platelet adhesion and aggregation. This case of KS suggests a pathophysiology in which the synergic effects between the coronary evaginations and a systemic allergic reaction may contribute to very late ST. For patients with Type 3 KS, performing follow-up intracoronary imaging tests may be important to confirm potential coronary evaginations, especially in patients with SESs.

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Section: Discussionmentioning

confidence: 99%