Life-threatening simultaneous acute stent thrombosis associated with anaphylactic shock due to contrast material

<span class="paragraphSection">A 66-year-old man with acute coronary syndrome (ACS) underwent emergent percutaneous coronary intervention (PCI) with implantation of two everolimus-eluting stents (EES) for severe stenosis in the proximal and distal right coronary artery (RCA) (<span style="font-style:italic;">Panel</span><span style="font-style:italic;">s</span><span style="font-style:italic;">A</span> and <span style="font-style:italic;">B</span>). At 1 week, after EES implantation, we performed staged PCI for the stenotic lesion in mid left circumflex artery (LCx) (<span style="font-style:italic;">Panel E</span>). After injection of contrast material into left coronary artery, blood pressure was 58/38 mmHg and the pulse rate 112 beats/min. He had an erythematous rash over all the body and complained of chest discomfort. Immediately, he was diagnosed anaphylactic shock, and intravenously administered 0.3 mg of epinephrine, 500 mg of hydrocortisone, 25 mg of diphenhydramine, and 20 mg of famotidine. However, because anaphylactic shock continued (blood pressure was 76/48 mmHg), we inserted intra-aortic balloon pump and continued to administer 0.16 μg/kg/min of epinephrine intravenously. After we put the direct implantation of EES (2.5/12 mm) in the mid LCx (<span style="font-style:italic;">Panel F</span>), we performed coronary angiography (CAG) of RCA. Surprisingly, CAG revealed simult...
Source: European Heart Journal - Category: Cardiology Source Type: research