In-Stent Thrombosis after Antiplatelet Therapy Conversion while Awaiting Coronary Bypass

Abstract

In-stent thrombosis (IST) is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization laboratory. This is a case of an 81-year-old man who presented with ST-elevation myocardial infarction. Right coronary artery (RCA) occlusion was suspected. RCA angiography and percutaneous coronary intervention were performed. Complicated left coronary artery disease was subsequently discovered. Per cardiothoracic surgeon request, the patient was transitioned from ticagrelor to clopidogrel therapy in preparation for coronary artery bypass grafting. The patient experienced IST the day before surgery while receiving clopidogrel. We examine this case, which highlights the complexity of antiplatelet therapy choice and the role of genetic testing in evaluation of IST risk.