1 EuroIntervention 2015;10:0-0 DOI: 10.4244/EIJV10I10A207 EuroIntervention 2015;10: e 1- e 6 published online e -article February 2015 DOI: 10.4244/EIJV10I10A208 e 1 © Europa Digital & Publishing 2015. All rights reserved. HOW SHOULD I TREAT? How should I treat subacute stent thrombosis in the context of brain haemorrhage with abciximab? Victoria Martín-Yuste 1 , MD; Luis Alvarez-Contreras 2 , MD; Manel Sabaté 1 *, MD PhD 1. Department of Cardiology, Hospital Clinic, Barcelona, Spain; 2. Cardiology Department, Interventional Cardiology Unit, Sant Pau Hospital, Barcelona, Spain Invited experts: Henning Kelbæk 1 , MD; Kari Saunamäki 1 , MD; Erik Jørgensen 1 , MD; Viktor Kočka 2 , MD 1. Medical Department B, Cardiac Catheterisation Laboratory, Rigshospitalet, Copenhagen, Denmark; 2. Cardiocenter, Department of Cardiology, Third Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic This paper also includes accompanying supplementary data published online at: http://www.pcronline.com/eurointervention/81st_issue/208 *Corresponding author: Department of Cardiology, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain. E-mail: masabate@clinic.ub.es PRESENTATION OF THE CASE A 56-year-old woman with a history of a cerebral aneurysm of 3.0 mm and breast cancer presented with sudden cardiac death. She was evaluated by emergency medical system personnel and referred for primary percutaneous coronary intervention (PCI) for an acute inferior myocardial infarction (MI) (Figure 1). The patient was placed in the cooling protocol for cerebral protection prior to being admitted for coronary angiography. Coronary angiography revealed an occlusion of the right coro- nary artery (RCA). A bolus and infusion of abciximab were admin- istered. Thrombectomy and bare metal stent implantation resolved the acute scenario (Figure 2). The patient showed a low weaning respiratory response and developed focal signs of neurological CASE SUMMARY BACKGROUND: A 56-year-old woman with a history of cere- bral aneurysm and breast cancer presented with acute inferior myocardial infarction. Primary PCI was carried out with stent deployment and triple antiplatelet therapy. She developed acute cerebral haemorrhage after abciximab infusion. Three days after primary PCI subacute stent thrombosis occurred. INVESTIGATION: High-burden stent thrombosis with con- traindication to glycoprotein IIb/IIIa antagonist use. DIAGNOSIS: Subacute stent thrombosis in a patient with a recent cerebral haemorrhage secondary to aspirin, clopi- dogrel and abciximab infusion. MANAGEMENT: Percutaneous coronary intervention. Throm- bus aspiration. KEYWORDS: distal protection device, glycoprotein IIb/IIIa antagonist, bleeding, stent thrombosis Figure 1. Inferior acute myocardial infarction.