Progressive angiographic haziness preceding intraprocedural stent thrombosis during primary PCI: A case report

Background: Angiographic haziness after coronary stent implantation is nonspecific and may represent thrombus, edge dissection, tissue protrusion, intramural hematoma, or stent underexpansion. Case summary: A 61-year-old man with anterior ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention (PCI) of a subtotal mid-left anterior descending artery lesion. One minute after implantation of a 3.0 × 26-mm zotaro-limus-eluting stent, new haziness appeared. It was interpreted as an edge dissection and treated with two additional proximal stents, after which the artery abruptly occluded and cardiogenic shock developed. Aspiration retrieved red thrombus, confirming intraprocedural stent thrombosis. Activated clotting time (ACT), fi rst measured 2 min after the onset of shock, was 150 s. Supplemental heparin and eptifi batide restored TIMI grade 2 fl ow. At staged intravascular ultrasound-guided reintervention on day 4, the vessel was larger than initially estimated and a fluoroscopic balloon waist suggested underexpansion; quantitative imaging data were lost. Conclusion: Thrombotic, anticoagulants, and mechanical abnormalities were documented at different time points, but their relative contribution cannot be established. Haziness that persists after a first mechanical correction should prompt verification of anticoagulation and intracoronary imaging before further stenting.