Very late thrombosis after implantation of sirolimus eluting stent

Abstract

Stent thrombosis after sirolimus eluting stent implantation has been reported to occur at six hours to 375 days after the procedure and usually within the two weeks after discontinuation of antiplatelet medication. A case is reported of very late stent thrombosis after 17 months of sirolimus eluting stent implantation and eight months after clopidogrel discontinuation despite aspirin continuation. This case underlines the possible need for long term antiplatelet medication among patients receiving sirolimus eluting stents.

Figures

Figure 1

(A) Baseline coronary angiography showing significant lesion in the mid segment of left anterior descending coronary artery (LAD; black arrow) and total occlusion of the first diagonal branch (white arrow). (B) Postprocedural coronary angiography after direct stenting in the mid segment of LAD with two overlapping Cypher stents (arrowheads) and balloon angioplasty in the first diagonal branch (black arrow). (C) Coronary angiography 17 months after the procedure showing total occlusion at the proximal edge of the proximal Cypher stent implanted in the mid segment of the LAD (white arrow) and no restenosis in the first diagonal branch (black arrow).