J Korean Med Sci.  2008 Jun;23(3):556-559. 10.3346/jkms.2008.23.3.556.

Very Late Stent Thrombosis after Drug-Eluting Stent Implantation in a Patient without Aspirin and Clopidogrel Resistance

• Lim SY
• Kim KS
• Joo SJ
• Jeong MH

• KMID: 1786903
• DOI: http://doi.org/10.3346/jkms.2008.23.3.556

Abstract

Very late stent thrombosis (VLST) after implantation of drug-eluting stent is rare, but very fatal complication after percutaneous coronary intervention. We report a case of VLST of a sirolimus-eluting Cypher(TM) stent (Cordis, Johnson and Johnson) presenting as acute ST elevation myocardial infarction at 26 months after deployment with continued combined dual antiplatelet medication of aspirin and clopidogrel. The patient did not show anti-platelet resistance.

Keyword

Stents; Thrombosis; Myocardial Infarction

MeSH Terms

Aged
Angina Pectoris/*therapy
Aspirin/*therapeutic use
Coronary Angiography
Coronary Thrombosis/drug therapy/*etiology/radiography
Drug Resistance
Drug-Eluting Stents/*adverse effects
Electrocardiography
Female
Humans
Platelet Aggregation Inhibitors/*therapeutic use
Ticlopidine/*analogs & derivatives/therapeutic use
Time Factors

Figure

• 

  Fig. 1 Coronary angiography (CAG) revealed a critical lesion in the middle left anterior descending artery (A). After percutaneous coronary intervention, CAG showed excellent final angiographic results (B).

• 

  Fig. 2 In July 2006, at 26 months after PCI, electrocardiogram at emergency room showed 5 mm ST segment elevation with tall T waves in precordial leads suggestive of acute anterior wall myocardial infarction.

• 

  Fig. 3 Emergent CAG revealed a thrombotic total occlusion of the middle LAD at 26 months after drug-eluting stent implantation (A). After balloon angioplasty, no residual stenosis was obtained with good distal flow (B).

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