LAUSR

Background: Stent thrombosis (ST) is a dreaded complication of percutaneous coronary intervention (PCI), however incidence has been declining with improvement in stent design and pharmacological treatments. While ST can occur at any time after placement of a stent, the rate of ST declines as time from implantation progresses. Case: A 54 year-old man with a history of hypertension, hyperlipidemia, type two diabetes mellitus and coronary artery disease status PCI to the left anterior descending artery (LAD) six years prior presented with substernal chest discomfort for three hours. Vital signs were within normal limits, and his electrocardiogram showed two-to-three-millimeter ST elevation across the precordial leads with reciprocal ST depressions. He was brought emergently to the cardiac catheterization lab where coronary angiography revealed a large thrombus within the previously placed LAD stent. The patient underwent aspiration thrombectomy, balloon angioplasty and stenting of the LAD. The patient was discharged in good condition on dual-antiplatelet therapy three days after his presentation. Decision-making: Since the beginning of the COVID-19 pandemic, physicians on the front lines have been learning more and more about the virus including prevention and treatment. In a stunning collaboration of science and enterprise, several vaccines were created including the Johnson & Johnson/Janssen (J&J) single dose COVID-19 immunization. However, although effective at preventing serious COVID-19 infections, anecdotal evidence of thrombotic events has been reported. Given this patient's thrombotic event, a hypercoagulable workup was undertaken but unrevealing. Conclusion: We describe a case of very late ST of a six year-old drug eluting stent occurring three weeks after the patient received a J&J COVID-19 vaccine. While temporally the timing of the stent thrombosis is surprising and possibly related, this is yet another case to add to the body of evidence as we learn more about the 2019 Novel Coronavirus and the COVID-19 vaccines as we navigate this pandemic together.