Abstract
Background
Very-very late stent thrombosis (VVLST) occurring more than five years after implantation of drug-eluting stent (DES) is extremely rare, being restricted to few case reports. Mainly described with 1st generation stents, this life-threatening complication has not been described with later-generation stents. We describe the first case of VVLST occurring 3309 days (> 9 years) after implantation of 2nd generation DES
Case summary
A 62-year-old male presented with the acute coronary syndrome. He has a history of percutaneous coronary intervention (PCI) to the right coronary artery (RCA) using the three second-generation DES more than nine years ago. Coronary angiogram revealed in-stent restenosis (ISR) with doubtful angiographic thrombus. Optical Coherence Tomography (OCT) confirmed the diagnosis of stent thrombosis (STh) localized to the stent overlap zone with underlying ISR. Patient underwent OCT guided PCI with DES implantation and was discharged on dual antiplatelet therapy including ticagrelor. He is doing well on follow-up at six months.
Discussion
STh can occur in second-generation stents nearly a decade after implant. Stent overlap segment is more prone to neo-atheroma formation and vulnerable plaque leading to STh. In addition to confirming the diagnosis, OCT provides exciting insights into the underlying mechanism. This has implications for long-term antiplatelet therapy in patients implanted with multiple stents.
Very Late Stent Thrombosis After Discontinuation of Antiplatelet Agents During Anticoagulation Therapy in a Patient with Peri-stent Contrast Staining After Implantation of a Second-generation Drug-eluting Stent
