Very very late thrombosis of a sirolimus-eluting stent: does suboptimal stent expansion take its toll even after three years?
We report the case of a 55-year-old man who underwent coronary angiography in 2004 for early angina following anterior ST-elevation myocardial infarction. Angiography disclosed a critical stenosis in the proximal left anterior descending artery and significant stenoses in the right coronary artery and first obtuse marginal branch, treated with two paclitaxel-eluting stents and a sirolimus-eluting stent, respectively. After completion of a six-month thienopyridine course and while still being on lifelong aspirin, in 2007 he was readmitted for lateral ST-elevation myocardial infarction: angiography revealed stent thrombosis beginning at the proximal edge of the sirolimus-eluting stent implanted in the first obtuse marginal branch. Intravascular ultrasound was performed after thrombectomy but before balloon dilation showing suboptimal stent expansion and a thrombus partially adhering to the sirolimus-eluting stent. The procedure was then successfully completed with the implantation of another sirolimus-eluting stent. This clinical vignette suggests that suboptimal drug-eluting stent deployment may be associated with stent thrombosis well after the traditional time frame of subacute thrombosis.
Bollati
Mario
M
Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy.
Biondi-Zoccai
Giuseppe G L
GG
Gambino
Alfonso
A
Lombardi
Primiano
P
Sheiban
Imad
I
D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011859:Radiography; D012086:Reoperation; D020123:Sirolimus / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D020123:Sirolimus