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Case Reports
. 2011 Dec 6;5(1):e8-e11.
doi: 10.1016/j.jccase.2011.10.007. eCollection 2012 Feb.

Recurrent episode of very late stent thrombosis in a patient who underwent percutaneous coronary intervention with sirolimus-eluting stent: Same or different mechanism?

Soon Yong Suh  1 , Woong Chol Kang  1 , Taehoon Ahn  1
Affiliations
Case Reports

Recurrent episode of very late stent thrombosis in a patient who underwent percutaneous coronary intervention with sirolimus-eluting stent: Same or different mechanism?

Soon Yong Suh et al. J Cardiol Cases. .

Abstract

We describe a case of a young patient with a recurrent episode of very late stent thrombosis (VLST) in whom the sirolimus-eluting stent was implanted on the culprit lesion in the left anterior descending artery. The present case showed when the etiology of VLST was not clear or in doubt of stent fracture, vigorous investigation for other causes using high resolution technology such as intravascular ultrasound or computed tomography angiography might be helpful for prevention of catastrophic events such as VLST.

Keywords: Sirolimus-eluting stent; Very late stent thrombosis.

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Figures

Figure 1
Figure 1
On first admission, coronary angiography demonstrated subtotal occlusion of mid left anterior descending artery (LAD) (open arrow) and diagonal artery (A). After pre-dilatation, sirolimus-eluting stent (2.75 mm × 28 mm) was deployed successfully at LAD lesion and balloon dilatation was performed at diagonal artery. Final angiography showed good distal flow (B). On second admission, coronary angiography showed complete occlusion (white arrow) of previous drug-eluting stent with thrombus at mid LAD (C). After continuous infusion of glycoprotein IIb–IIIa inhibitor and balloon dilation, coronary flow was restored without thrombosis (D).
Figure 2
Figure 2
Two and half years after the second percutaneous coronary intervention, he revisited our emergency room again due to chest pain. Coronary angiography showed total occlusion of the same site in the previous drug-eluting stent (DES) at mid left anterior descending artery (A). Furthermore, misalignment of stent, which is suggestive of stent fracture (SF), was noted at middle of stent (dotted line, B). Intravascular ultrasound investigation revealed complete separation of proximal and distal stent strut corresponding to SF on angiography (C). The lesion was treated with another DES (2.75 mm × 30 mm). Follow-up angiography showed good distal flow (D).
See this image and copyright information in PMC

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