A case of "very" very late stent thrombosis: More than 12 years after DES

Abstract

A rare but possibly catastrophic consequence of drug-eluting stents (DES) is very late stent thrombosis. We report a case of 74-year-old male who sustained a ST elevation myocardial infarction (STEMI) 12 years after initial Paclitaxel eluting stent implantation (PES). This is the longest time between stent placement and the development of an acute coronary event due to very late stent thrombosis that we are aware of (VLST). The implications for prognosis and therapy are significant because they highlight the uncertainty around the recommended duration of antiplatelet medication in patients with DES. Clinicians face challenges in treating those patients particularly when competing medical conditions demand the discontinuation of antiplatelet therapy. VLST is concerning since the underlying pathophysiology is unknown, and the best preventive treatments and duration of antiplatelet medication after stent implantation are unknown.

Keywords: Coronary artery disease; drug-eluting stents; neoatherosclerosis; neointima; paclitaxel eluting stent; very late stent thrombosis.

Figure 1

Occluded 2.5 × 15 taxcor old stent

Figure 2

New stent with guide wire (3 × 32 R ONYX)

Figure 3

TIMI 3 flow after stenting