title: Simultaneous very late stent thrombosis in multiple coronary arteries.
abstract: We report 2 noteworthy cases of very late stent thrombosis presenting as ST-segment-elevation myocardial infarction, with vastly different manifestations. Both patients were women who had histories of multivessel percutaneous coronary intervention with first-generation sirolimus-eluting stents, in 2005 and 2006. On the more recent occasions reported here, one underwent successful multivessel primary percutaneous coronary intervention, while the other underwent successful multivessel "plain old balloon angioplasty." Both were discharged from the hospital with advice to stop smoking and to follow a lifelong regimen of aspirin and clopidogrel.On the basis of these two cases and our review of the current literature, we ask whether it is now prudent to recommend lifelong dual antiplatelet therapy after drug-eluting stent deployment. Moreover, in order to account for cases of stent thrombosis that occur ≥ 5 years after drug-eluting stent implantation, should we perhaps suggest the addition of "extremely late stent thrombosis" to the existing Academic Research Consortium classification?
authors.affiliation: Department of Medicine, Cardiovascular Division, Montefiore-Einstein Heart Center, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York 10461, USA. docsesh@gmail.com
authors.forename: Seshasayee
authors.initials: S
authors.lastname: Narasimhan
authors.forename: Nassim Rostane
authors.initials: NR
authors.lastname: Krim
authors.forename: Gary
authors.initials: G
authors.lastname: Silverman
authors.forename: Ernest Scott
authors.initials: ES
authors.lastname: Monrad
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus
keywords: Aspirin; ST-elevation myocardial infarction; clopidogrel; coronary restenosis/etiology; coronary thrombosis/etiology; drug delivery systems/adverse effects; immunosuppressive agents; paclitaxel; platelet aggregation inhibitors/therapeutic use; sirolimus/therapeutic use; stent thrombosis; stents, drug-eluting/adverse effects; very late stent thrombosis