title: Very late stent thrombosis due to DES fracture: description of a case and review of potential causes.
abstract: Stent fracture and subsequent stent thrombosis are known complications after stent implantation, especially in stents with closed cell design like the first generation sirolimus drug eluting stents (DES). Late stent thrombosis is very rarely encountered in our patient population, majority Chinese. We report a case of non-ST elevation myocardial infarction as a result of very late stent thrombosis (three years after implantation) due to stent fracture at the site of overlap of two first generation sirolimus DES. There were initial difficulties in restoring coronary flow by conventional reperfusion therapies but a successful outcome after implantation of an endothelial progenitor cell capture stent, with no further recurrence of ischemic event after 12 months. An attempt was made to analyze all existing factors present and contributing to the stent fracture and stent thrombosis in this case, as reported in the literature.
authors.affiliation: Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. drsl@i-cable.com
authors.forename: Stephen W L
authors.initials: SW
authors.lastname: Lee
authors.forename: Frankie C C
authors.initials: FC
authors.lastname: Tam
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: Chan
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus