Five years on dual-antiplatelet therapy. DES thrombosis after clopidogrel withdrawal.
Drug-eluting stents (DES) have a moderately higher incidence of stent thrombosis compared to bare metal stents (BMS) and very late DES thrombosis has been frequently described. We report a case of a 66 year-old male who experienced very late stent thrombosis at 5 years after paclitaxel-eluting stent (PES) implantation and 3 days after clopidogrel withdrawal. Intravascular ultrasound (IVUS) performed during the index procedure showed that the previously implanted PES was undersized. Since the patient could not take clopidogrel, we treated him with only a noncompliant balloon (3.0 × 15 mm) with optimal expansion as confirmed by IVUS. This case report describes a patient who continued clopidogrel treatment for 5 years and was probably protected from a procedural failure. During the current hospitalization, the patient was found to be a responder to clopidogrel after a platelet function assessment with Multiplate (Dynabyte Informationssysteme GmbH, Munich, Germany).
Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome Sapienza, Italy.
Mauro
M
Pennacchi
Rocco Edoardo
RE
Stio
Luigi
L
Lucisano
Simone
S
Calcagno
Massimo
M
Mancone
Gennaro
G
Sardella
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000494:pharmacology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D018084:Ultrasonography, Interventional; D028761:Withholding Treatment
D000972:Antineoplastic Agents, Phytogenic; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel