Intraprocedural Acute Stent Thrombosis of Unusual Etiology

Stent thrombosis is a rare but potentially fatal complication of percutaneous coronary intervention (PCI), typically associated with a combination of factors, such as issues with the stent itself (poor expansion, malapposition), patient-associated factors (non-compliance with antiplatelet medication, hypercoagulability), and procedural issues (vascular injury, incomplete lesion coverage). This article presents two unique cases of acute stent thrombosis occurring within minutes of stent deployment, attributed to embolization of cotton fibers (lint) from surgical drapes and reused instruments. In both cases, thrombosuction revealed fibrous foreign material as the underlying cause. Despite the acute and severe presentation, timely intervention with repeated thrombosuction, intracoronary pharmacotherapy, and balloon dilatation successfully restored coronary flow to TIMI III flow (thrombolysis in myocardial infarction score). These cases underscore the importance of strict contamination control, the use of lint-free materials, and adherence to sterile techniques in catheterization labs. Enhanced awareness and preventive protocols can significantly reduce the incidence of such rare but serious complications.