Very late stent thrombosis associated with COVID-19 infection: a case report and review of the literature

Abstract

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.

Acute Aortic Stent Graft Thrombosis in Patient with Recent COVID-19 Infection

“…In our case, another additional risk factor for thrombosis, compared with other COVID-19 patients, was the presence of the aortic stent graft, which may have been the ideal substrate to platelet aggregation. Some papers in the current available literature have investigated coronary stent thrombosis in patients with SARS-CoV-2 infection [23][24][25]. The mechanism involved in aortic graft thrombosis is most likely the same as that which occurs in coronary stents, with a much lower degree of incidence that could be explained by the larger diameter of an aortic graft compared to a coronary stent.…”

COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA)

“… 4 This is primarily attributed to the COVID-19 induced procoagulant state, which may also predispose to stent thrombosis. 5 There is lack of clarity regarding the most appropriate revascularization strategy in these cases, especially in resource-limited low-middle income countries (LMIC) such as India. Patients are often denied primary PCI due to either lack of resources or fear of spread of COVID-19 infection to the already burdened health care workers.…”