Catheter Cardiovasc Interv. 2025 Dec 2. doi: 10.1002/ccd.70398. Online ahead of print.

In-stent thrombosis is a rare but devastating complication following percutaneous coronary intervention, and its risk may be significantly heightened by the pro-inflammatory and hypercoagulable state induced by COVID-19 infection. This case report details a 62-year-old male with acute non-ST-elevation myocardial infarction who underwent successful drug-eluting stent implantation, only to develop catastrophic in-stent thrombosis and cardiac rupture within one hour post-procedure, concurrent with a mild COVID-19 infection. Despite emergency thrombectomy and surgical intervention, the patient succumbed to refractory cardiogenic shock. This case, alongside a review of similar published reports, underscores the alarmingly rapid onset of stent thrombosis in COVID-19 patients and suggests that the viral infection acts as a potent precipitating factor. The pathophysiology likely involves immune-mediated endothelial injury, platelet hyperreactivity, and a systemic inflammatory cascade. The discussion highlights the critical need for heightened vigilance, consideration of intensified peri-procedural antithrombotic strategies (such as glycoprotein IIb/IIIa inhibitors), and the potential role of intravascular imaging in this high-risk patient population. This report concludes that managing acute coronary syndrome in the context of COVID-19 requires a personalized and aggressive approach to mitigate the elevated threat of early stent thrombosis.

PubMed:41332121 | DOI:10.1002/ccd.70398