Kunisov sindrom i rana tromboza stenta
Sažetak
Uvod. Kunisov sindrom je istovremena manifestacija akutnog koronarnog sindroma i stanja udruženih sa aktivacijom mastocita, kao što su alergija i anafilaktička reakcija. Prikazujemo slučaj rane tromboze stenta kod žene sa atopijskom konstitucijom, bez prethodnog postojanja aterosklerotskih lezija. Prikaz bolesnika. Pedesetogodišnja žena sa tipičnim anginoznim bolom primljena je na Kliniku za kardiologiju Univerzitetskog kliničkog centra u Nišu. Nekoliko sati ranije, ona je prošla pored drveta lipe u cvetanju. Odmah je osetila bol u grudima, parestezije i utrnulost leve ruke, stezanje u grlu, otežan jezik i otok usana. Tegobe su prestale tokom 60 min nakon uzimanja 10 mg loratadina, ali su se ponovo javile. Na elektrokardiografskom (EKG) nalazu, 30 min nakon prijema, viđena je ST elevacija u odvodima D2, D3, aVF i V6. Urađena joj je perkutana koronarna intervencija. Angiogram je pokazao okluzivnu trombozu ostijalnog dela prednje silazne grane leve (left anterior descending – LAD) koronarne arterije. Plasiran je sirolimusom obložen stent i postignut thrombolysis in acute myocardial infarction – TIMI 3 protok. Nekoliko sati nakon intervencije, bolesnica je prijavila da ponovo oseća bol u grudima, što je bilo praćeno ventrikularnom fibrilacijom (VF), DC šokom i pojavom elevacije ST segmenta u aVR i V1–V3 na EKG-u. Ponovljena angiografija je pokazala akutnu in-stent trombozu sa okluzijom. Urađena je balon angioplastika kojom je obnovljen TIMI 3 protok u LAD koronarnoj arteriji. Primenjena je antikoagulantna i kortikosteroidna terapija. Tri dana nakon intervencije, urađena je optička koherentna tomografija, koja je pokazala dobru ekspanziju stenta i apoziciju, bez ateroskleroze i tromboze. Zaključak. Koronarografijom je dokazan tip I Kunisovog sindroma nakon ekspozicije alergenu i tip III Kunisovog sindroma ubrzo nakon postavljanja stenta, kada je nastala akutna in-stent tromboza. Novoopisani uzroci akutne i subakutne tromboze stenta kod Kunisovog sindroma tipa III su hipersenzitivne reakcije povezane sa stentom.
Reference
Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med 2016; 54(10): 1545–59.
Kounis NG, Mazarakis A, Tsigkas G, Giannopoulos S, Goudevenos J. Kounis syndrome: a new twist on an old disease. Future Cardiol 2011; 7(6): 805–24.
Kounis NG, Koniari I, Velissaris D, Tzanis G, Hahalis G. Kou-nis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Med J 2019; 36(4): 212–21.
Liang HZ, Zhao H, Gao J, Cao CF, Wang WM. Epirubicin-induced Kounis syndrome. BMC Cardiovasc Disord 2021; 21(1): 133.
Nikolaidis LA, Kounis NG, Gradman AH. Allergic angina and allergic myocardial infarction: a new twist on an old syndrome. Can J Cardiol 2002; 18(5): 508–11.
Yagi H, Amiya E, Ando J, Watanabe M, Yanaba K, Ikemura M, et al. In-stent restenosis exacerbated by drug-induced severe eosinophilia after second-generation drug-eluting stent im-plantation. Am J Case Rep 2014; 15: 397–400.
Poggiali E, Benedetti I, Vertemati V, Rossi L, Monello A, Giovini M, et al. Kounis syndrome: from an unexpected case in the Emergency Room to a review of the literature. Acta Biomed 2022; 93(1): e2022002.
Akbaş T, Kaya A, Altun G, Eşbah Ü, Önmez A. Cases of aller-gic coronary syndrome (Kounis syndrome): what we should know. Nagoya J Med Sci 2022; 84(3): 664–72.
Pejcic AV, Milosavljevic MN, Jankovic S, Davidovic G, Folic MM, Folic ND. Kounis Syndrome Associated With the Use of Di-clofenac. Tex Heart Inst J 2023; 50(1): e217802.
Li J, Zheng J, Zhou Y, Liu X, Peng W. Acute coronary syndrome secondary to allergic coronary vasospasm (Kounis Syndrome): a case series, follow-up and literature review. BMC Cardiovasc Disord 2018; 18(1): 42.
Kounis NG, Koniari I, Roumeliotis A, Tsigkas G, Soufras G, Grapsas N, et al. Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome. J Thorac Dis 2017; 9(4): 1155–64.
Koniari I, Kounis NG, Hahalis G. In-stent restenosis and thrombosis due to metal hypersensitivity: implications for Kounis syndrome. J Thorac Dis 2016; 8(11): 3056–8.
McManus LM, Morley CA, Levine SP, Pinckard RN. Platelet activating factor (PAF) induced release of platelet factor 4 (PF4) in vitro and during IgE anaphylaxis in the rabbit. J Immunol 1979; 123(6): 2835–41.
Hasegawa S, Pawankar R, Suzuki K, Nakahata T, Furukawa S, Okumura K, et al. Functional expression of the high affinity receptor for IgE (FcepsilonRI) in human platelets and its' intracellular expression in human megakaryocytes. Blood 1999; 93(8): 2543–51.
Tripolino C, Tassone EJ, Morabito G, Grillo P, Missiroli B. Acute coronary stent thrombosis: A case of type 3 Kounis syndrome. J Cardiol Cases 2018; 19(1): 33–5.
Wang Q, Ren Y, Babar Shahzad M, Zhang W, Pan X, Zhang S, et al. Design and characterization of a novel nickel-free cobalt-base alloy for intravascular stents. Mater Sci Eng C Mater Biol Appl 2017; 77: 565–71.
Jimba T, Hashikata T, Matsushita M, Yamasaki M. Repetitive restenosis in a biodegradable polymer sirolimus-eluting stent with hypersensitivity reaction: a case report. Eur Heart J Case Rep 2020; 4(1): 1–5.
Miura S, Yamashita T, Murata M, Kounis NG. Uncommon but imperative cause of repeated acute stent thrombosis: Kounis syndrome type III. BMJ Case Rep 2021; 14(3): e240704.
Yamaji K, Kubo S, Inoue K, Kadota K, Kuramitsu S, Shirai S, et al. Association of localized hypersensitivity and in-stent neoath-erosclerosis with the very late drug-eluting stent thrombosis. PLoS One 2014; 9(11): e113870.
Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, et al. Localized hypersensitivity and late coronary throm-bosis secondary to a sirolimus-eluting stent: should we be cau-tious? Circulation 2004; 109(6): 701–5.
Omri M, Kraiem H, Mejri O, Naija M, Chebili N. Management of Kounis syndrome: two case reports. J Med Case Rep 2017; 11(1): 145.
Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol 2010; 143(3): 223–6.
Memon S, Chhabra L, Masrur S, Parker MW. Allergic acute coronary syndrome (Kounis syndrome). Proc (Bayl Univ Med Cent) 2015; 28(3): 358–62.
Hangouche AJE, Lamliki O, Oukerraj L, Dakka T, Doghmi N, Zarzur J, et al. Kounis syndrome induced by oral intake of as-pirin: case report and literature review. Pan Afr Med J 2018; 30: 301. Erratum in: Pan Afr Med J 2019; 33: 172.