Abstract
Lately, there has been an increased incidence of late stent thrombosis; especially following Drug eluting stent (DES) implantation. Several factors are associated with an increased risk of stent thrombosis, including the procedure itself, patient and lesion characteristics, stent design, and premature cessation of anti-platelet drugs. We present a case of late stent thrombosis (LST) following DES implantation after a period of 68 months, making it the longest reported case of LST reported in the literature, despite the use of dual anti-platelet therapy.
Highlights
Several randomized clinical trials have shown that implanting Drug eluting stents (DES) result in clinically significant reductions of in-stent re-stenosis compared with Bare metal stents (BMS) [1,2]
Stent thrombosis (ST) is classified by Academic Research Consortium into four types based on the time of event as; Acute: within 24 hours, Subacute: 24 hours to 30 days, Late: after 30 days, and very late: after 12 months
Angioscopic and optical coherence tomography studies have shown that lack of complete endothelialization of DES to be the most important predictor of Late Stent thrombosis (LST) [8,9]
Summary
Several randomized clinical trials have shown that implanting Drug eluting stents (DES) result in clinically significant reductions of in-stent re-stenosis compared with Bare metal stents (BMS) [1,2]. Our patient experienced very late stent thrombosis, occurring 68 months post DES implantation, making it the longest time-to-event, reported in the literature. Case presentation A 75-year-old Caucasian gentleman had presented to our emergency department 5 years and 8 months ago (2003) with chest pain secondary to anterior wall STsegment elevation myocardial infarction. His past medical history was significant for hypertension and dyslipidemia with a 50 pack years smoking history. A persantine-technetium 99 myocardial perfusion imaging stress test carried out was interpreted as positive for anterior wall reversible ischemia Few days later, he presented to our hospital with sudden onset chest tightness and an EKG showing ST-segment elevation in leads V1-2. After 3 days of hospitalization patient was discharged on daily medications of aspirin 325 mg daily and clopidogrel 75 mg daily, atorvastatin 80 mg, isosorbide mononitrate 30 mg daily, atenolol 50 mg daily and lisinopril 20 mg daily
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