Drug-eluting stent thrombosis 1,659 days after stent deployment: case report and literature review

Abstract

Drug-eluting stents are considered to be superior to bare-metal stents in reducing restenosis rates at 6 months. However, drug-eluting stents appear to be subject to stent thrombosis, a concern that has been reported more frequently in recent times. In November 2003, a 64-year-old man with a medical history of hypertension, type 2 diabetes mellitus, and coronary artery disease underwent percutaneous coronary intervention for the deployment of a sirolimus-eluting stent in the left anterior descending coronary artery. He experienced no complications. More than 4 years later, at age 69, he underwent neurosurgical treatment for a subdural hematoma that resulted from a fall, and he was advised to stop taking aspirin and clopidogrel. Thirty-three days later--1,659 days after stent deployment--he presented with a clinical event that was associated with very late stent thrombosis. After undergoing emergent coronary angiography and the placement of 2 bare-metal stents, he resumed antiplatelet therapy, recovered uneventfully, and was discharged from the hospital in stable condition. To the best of our knowledge, 1,659 days is the longest reported interval between the deployment of a drug-eluting stent and the occurrence of a clinical event that was associated with very late stent thrombosis. Herein, we discuss the case of our patient, review the pertinent medical literature, reinforce the importance of continuous and uninterrupted antiplatelet therapy in drug-eluting stent recipients, and offer considerations regarding the use of drug-eluting stents.

Keywords: Angioplasty, transluminal, percutaneous coronary/adverse effects; coronary artery disease/therapy; coronary restenosis/epidemiology/etiology/prevention & control; coronary thrombosis/etiology; coronary vessels/pathology; drug therapy, combination; drug-eluting stents/adverse effects; platelet aggregation inhibitors/administration & dosage/therapeutic use; thrombosis/epidemiology/etiology; time factors.

Fig. 1 Angiographic images (right anterior oblique cranial view) show A) 99% obstruction of the mid left anterior descending coronary artery (arrow) and B) the same region after the deployment of a drug-eluting stent (arrow).

Fig. 2 Electrocardiogram shows ST elevation, consistent with anterior-wall myocardial infarction.

Fig. 3 Angiographic images (right anterior oblique cranial view) show A) occlusion of the left anterior descending coronary artery and thrombosis of the drug-eluting stent (arrow), and B) the restoration of arterial luminal diameter after the deployment of 2 bare-metal stents (arrow).