Very Late Stent Thrombosis in Late Stent Malapposition After Sirolimus-Eluting Stent Implantation

Abstract

SUMMARYLate stent malapposition (LSM) has been demonstrated to be more common after drug-eluting stent (DES) implantation than after bare-metal stent (BMS) implantation. To date, this unusual intravascular ultrasonic finding after DES implantation, however, has not received enough attention, because previous studies suggested few adverse clinical sequelae from LSM. We present a case of angiographically-confirmed very late stent thrombosis (ST) in LSM after elective implantation of sirolimus-eluting stents. In this 32-year-old male patient, very late ST occurred at 29 months after DES implantation and at 20 months after the identification of LSM. Although this patient had received sufficient dual antiplatelet therapy with aspirin and clopidogrel for more than 1 year, he suffered from ST shortly after the discontinuation of clopidogrel. Thus, patients with LSM may pose a significant risk for very late ST after discontinuation of dual antiplatelet therapy. The findings suggest that dual antiplatelet therapy should be further prolonged in patients with LSM. ( Despite these promising results, some studies found an increased rate of late stent malapposition (LSM) in DESs compared to traditional bare-metal stents (BMSs). [4][5][6][7] To date, this unusual intravascular ultrasound (IVUS) finding after DES implantation, however, has not received enough attention, because almost all of the previous studies suggested few adverse clinical sequelae from LSM. [4][5][6][7][8] We present here a case of angiographically-confirmed very late stent thrombosis (ST) in LSM after elective implantation of sirolimus-eluting stents (SESs) to draw more attention to the significance of LSM in DESs.From the

Direct Stenting Versus Predilatation and Stenting Technique When Using Paclitaxel-Eluting Stents

“…Another limitation is that not all but only 70% of the lesions were available for follow-up analysis of coronary angiography. Another limitation of our study is that we have no data regarding late stent malapposition, which may result in stent thrombosis, 31) as we do not perform routine intravascular ultrasound during follow-up.…”

Fatal Very Late Stent Thrombosis in a Young Diabetic Patient With Severely Diffuse Coronary Atherosclerosis

“…[1][2][3][4][5][6][7] The incidence of late stent thrombosis is infrequent, but it might be a fatal event. The reported incidence of late stent thrombosis after DES implantation has been reported to range between 0.3% and 0.7%.…”

“…Adherence to long-term antiplatelet therapy plays an important role in the prevention of late stent thrombosis. [1][2][3][4][5][6][7] This case report describes fatal very late stent thrombosis in a young diabetic patient with severely diffuse coronary atherosclerosis who had nonadherence to antiplatelet therapy and diabetic treatments.…”

“…Late stent thrombosis after drug-eluting stent (DES) placement has emerged as a major concern. [1][2][3][4][5][6][7] Stent thrombosis is an infrequent event but a potentially fatal complication of coronary stenting. Adherence to long-term antiplatelet therapy plays an important role in the prevention of late stent thrombosis.…”

Six-year clinical outcomes of first-generation drug-eluting stents

“…This initial advantage of DES over BMS might be reduced by a later increase in the risk of stent thrombosis and TLR (the so-called late 'catch-up' phenomenon) [9][10][11][12]. The wide use of SES and PES in clinical practice has provided a vast amount of clinical data.…”