scholarly journals Right coronary artery thrombosis within drug eluting stents more than 10 years after deployment

2017 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Sam Lovibond ◽  
Michael Leung
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Artery Thrombosis ◽  
Coronary Artery Thrombosis ◽  
Drug Eluting ◽  
Initial Drug

We present two rare cases of very late stent thrombosis (VLST) occurring beyond ten years post initial drug eluting stent (DES) deployment

Abstract 2566: Late and Very Late Stent Thrombosis following Elective Drug Eluting Stent Implantation in Unprotected Left Main Coronary Artery: a Multicentre Registry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alaide Chieffo ◽  
Young H Kim ◽  
Emanuele Meliga ◽  
Seung J Park ◽  
Marco Valgimigli ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Left Main Coronary Artery ◽  
Drug Eluting Stent ◽  
Late Stent Thrombosis ◽  
Left Main ◽  
Very Late Stent Thrombosis ◽  
Drug Eluting

The long-term safety of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. Some concerns have been recently raised regarding the risk of late and very late stent thrombosis (ST). Methods: All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and June 2006 were included in this multicentre registry. Stent thromboses were defined according to Academic Research Consortium (ARC) definitions. Results Five-hundred and thirty-four consecutive patients were analyzed: 357 patients were treated with SES, 168 with PES and 9 with both of them. One-hundred and thirty-eight (25.8%) patients were diabetics, 171 (32.0%) unstable angina, mean age 62.4 ± 11.4 years, EF 54.1 ± 11.2 %. Distal location occurred in 417 (78.0%) of the patients. Fifty-seven (10.6%) patients had a peri-procedural myocardial infarction (defined as CK-MB elevation ≥3 ULN). At 1044 ± 361 day clinical follow-up, 32 (5.9%) patients died: 23 (4.3%) were adjudicated as cardiac according to ARC definition. One patient had an acute ST (with cardiogenic shock treated with CABG), 1 a sub-acute ST (occlusion of circumflex artery treated with PCI) and 1 a late definite ST (in the left anterior descending artery with MI at 3 months while on antiplatelet therapy). None of the patients had a very late definite ST. In the Table are reported probable and possibile ST. Conclusions Treatment of LMCA stenosis with DES appears safe at long-term clinical follow-up with a 0.6% incidence of definite and probable ST at a median follow-up of almost 3 years. Table.

scholarly journals Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent

2015 ◽  
Vol 42 (5) ◽  
pp. 487-490 ◽  
Author(s):  
Kevin Liou ◽  
Nigel Jepson
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Stent Insertion ◽  
Late Stent Thrombosis ◽  
Neointimal Formation ◽  
Very Late Stent Thrombosis ◽  
St Segment Elevation ◽  
Drug Eluting

Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.

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