title: A case report of very late stent thrombosis with peri-stent coronary artery aneurysm and stent-related coronary vasospasm.
abstract: We describe a 42-year-old man with very late stent thrombosis (VLST) 35 months after implantation of a sirolimus-eluting stent (SES). Three months after the VLST episode, a follow-up angiography showed a formation of peri-stent coronary artery aneurysm. Sixty-five months after SES implantation, the patient suffered an out-of-hospital cardiac arrest. We performed spasm provocation test using acetylcholine to evaluate coronary vasomotor response and the coronary segments adjacent to the SES showed significant vasoconstriction. Intracoronary pretreatment of Rho-kinase inhibitor, fasudil, markedly attenuated acetylcholine-induced vasoconstriction. This report documents a unique case suffering from multiple fatal complications after SES implantation.
authors.affiliation: Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Nasushiobara, Japan. mtakeda@iuhw.ac.jp
authors.forename: Morihiko
authors.initials: M
authors.lastname: Takeda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shiba
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000328:Adult; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000209:etiology*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology*; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D020123:Sirolimus / Q000494:pharmacology*; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus