Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent.
Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.
Kevin
K
Liou
Nigel
N
Jepson
D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000209:etiology; D002317:Cardiovascular Agents / Q000008:administration & dosage; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D054855:Drug-Eluting Stents; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D011474:Prosthesis Design; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D020123:Sirolimus
Coronary disease/drug therapy; coronary restenosis/diagnosis/prevention & control; disease progression; drug-eluting stents/adverse effects; neointima/diagnosis/etiology/pathology; retreatment/methods; thrombosis/prevention & control; time factors; tomography, optical coherence/methods; treatment outcome