Catastrophic multisite arterial and venous thrombosis after apparently uncomplicated percutaneous coronary intervention: a case report

Thrombotic events after percutaneous coronary intervention (PCI) usually involve the coronary circulation, most commonly presenting as acute coronary thrombosis or stent thrombosis. By contrast, thrombotic events involving non-coronary vascular beds are uncommon, and multisite thrombosis involving both arterial and venous systems is particularly rare. Early manifestations are often non-specific, making timely diagnosis challenging. Delayed recognition may allow these complications to progress rapidly, resulting in catastrophic and potentially irreversible outcomes. A 63-year-old woman was admitted with recurrent chest tightness, palpitations, and oedema. Coronary angiography revealed severe stenosis in the mid segment of the right coronary artery (RCA), and a drug-eluting stent was deployed uneventfully. Approximately 6 h after PCI, she developed acute abdominal pain, followed by vomiting, black loose stools, marked leukocytosis, and radiographic evidence of small-bowel obstruction. Abdominal computed tomography angiography (CTA) demonstrated portal vein and superior mesenteric vein thrombosis, as well as superior mesenteric artery thrombosis. Shortly thereafter, right upper-limb arterial thrombosis was also identified. The patient underwent emergency superior mesenteric artery thrombectomy, partial ileal resection with ileo-ileal anastomosis, and right brachial artery thrombectomy. A subsequent acute RCA or stent-related thrombotic event was clinically suspected but was not angiographically confirmed. She recovered after individualized antithrombotic therapy and multidisciplinary management, with no clinically apparent recurrent thrombotic or major bleeding events during 24 months of follow-up. This case demonstrates that a catastrophic multisite thrombotic process involving both arterial and venous vascular beds can occur in the early period after PCI, although a causal relationship with PCI cannot be established from a single case. Persistent, progressive, or disproportionate abdominal pain after PCI should prompt consideration of acute mesenteric ischaemia and early CTA. Timely multidisciplinary assessment and individualized treatment may be critical for improving outcomes.