title: Late angiographic stent thrombosis after sirolimus-eluting stent implantation.
abstract: BACKGROUND
  Although drug-eluting stents dramatically reduce revascularization after percutaneous coronary intervention (PCI), it is still unclear whether they increase the risk of stent thrombosis. Late stent thrombosis (>30 days) was a very rare complication after bare metal stent implantation. Four cases of confirmed late angiographic stent thrombosis (LAST) after sirolimus-eluting stent (SES) implantation are presented and the incidence, promoting factors and outcomes of such cases in Japan, where clopidogrel has not been approved, are described.
  
  
  RESULTS
  Between September 2004 and March 2006, 725 patients underwent PCI with SES implantation and 679 patients (94%) were clinically followed up (median 271 days). There were 4 cases (0.6%) of LAST (at 60, 180, 215, and 508 days, respectively) after elective SES implantation resulting in myocardial infarction. Three cases occurred soon after antiplatelet therapy discontinuation 3 patients died after LAST events. The incidence of LAST was 0.6%.
  
  
  CONCLUSIONS
  LAST is a rare complication, even after SES implantation, at least in patients with appropriate antiplatelet therapy. However, as it can lead to fatal complications, it must be taken into account, especially when antiplatelet therapy is discontinued.
authors.affiliation: Division of Cardiology & Catheterization Laboratories, Heart Center of Shonan Kamakura General Hospital, Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Takaaki
authors.initials: T
authors.lastname: Shiono
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taketani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Domae
authors.forename: Junya
authors.initials: J
authors.lastname: Matsumi
authors.forename: Shingo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugitatsu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus