Preventing kounis syndrome by stent implantation: A reciprocal process? Reply

Abstract

Coronary stent implantation is a life-saving procedure that has nowadays become the most frequently performed therapeutic procedure in medicine. However, the site of stent implantation usually becomes vulnerable for endothelial damage and disturbed vasomotion that can lead to stent thrombosis. In the very interesting report published in this journal by Terzioğlu et al. (1) entitled "Kounis syndrome not induced but prevented by the implantation of a drug eluting stent: a case report.", a 65-year-old male patient with hypertension and diabetes who underwent bypass graft surgery developed an acute allergic reaction with dyspnea, itching, hand swelling, retrosternal chest pain, and syncope following paracetamol/ propyphenazone tablet administration. Type II Kounis syndrome was diagnosed, which manifested as non-STEMI. Coronary arteriography revealed a severe midportion circumflex artery stenosis, and a paclitaxel-eluting stent was implanted, which gave favorable results. However, after 10 months, the patient again inadvertently received paracetamol/propyphenazone combination and developed urticaria, angioedema, and dyspnea within 10 min. His symptoms disappeared with an antiallergic treatment. This report raises important issues concerning allergy, Kounis syndrome, stent implantation benefits, and the role of stent composition in the pathophysiology of stent thrombosis.