Coronary stent thrombosis: beware of an allergic reaction and of Kounis syndrome.

During their everyday practice, physicians are encountering some unexpected, peculiar, bizarre, strange, surprising, extraordinary and astonishing events that need quick explanation and emergency treatment. According to these events, patients with coronary stent implantation who accidentally developed an allergic reaction elsewhere in the human body from various causes developed, contemporarily, the much feared intrastent thrombosis. For example, acute myocardial infarction, in the stented area, has coincided with allergic reaction following intravenous administration of the nonanionic contrast material iopromide during a routine excretory urography. Stent thrombosis has been associated with allergic symptoms such as glottis edema, cold sweat, and tongue enlargement following a flavonate-propyphenazone administration a week after stent implantation. Intrastent thromboses have also been reported following insect and larvae sting-induced allergic reactions. Late drug eluting stent thrombosis defined as type III variant of Kounis syndrome has occurred following an allergic reaction to non steroidal anti-inflammatory agent acemetacine. The astonishing event is that even an allergic reaction to clopidogrel, the drug that is given to prevent stent thrombosis, itself has induced stent thrombosis! An additional report published in Indian Heart Journal was referred to a 60-year-oldmale patient with stent implantation for critical left anterior descending coronary artery stenosis who developed stent thrombosis following a snake bite. This patient was thrombolysed and his coronary angiogram, 5 days later, revealed patent stent with TIMI III flow and no evidence of thrombus. All above reports were concerning patients who were receiving multiple medications, known to induce allergic reactions, following stent implantation. Therefore, one can