Author + information
- Arend F.L. Schinkel, MD, PhD⁎,⁎ (, )
- Peter Barlis, MD⁎,
- Heleen M.M. van Beusekom, MD, PhD†,
- Patrick W. Serruys, MD, PhD, FACC⁎ and
- Evelyn Regar, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Arend F. L. Schinkel, Department of Cardiology, Thoraxcenter Room Ba316, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
- coronary angioplasty
- intravascular ultrasound
- intravascular optical coherence tomography
- stent thrombosis
The mechanisms of late coronary stent thrombosis, a complication with high morbidity and mortality (1), are poorly understood. Late thrombosis in drug-eluting coronary stents has been associated with delayed endothelization of the stent struts or systemic and intrastent hypersensitivity reaction (2). We present in vivo findings in a patient with very late stent thrombosis. In 2003, a 60-year-old man with a history of stable angina and smoking underwent elective placement of 2 overlapping paclitaxel-eluting stents (3.0 · 16 mm and 2.75 · 28 mm, Taxus stent, Boston Scientific, Natick, Massachusetts) and post-dilation with a noncompliant balloon, for a significant stenosis of the left anterior descending artery. The discharge medication consisted of aspirin, clopidogrel (12 months), beta-blockers, and statins. Four years after stenting, the patient presented with acute anterior myocardial infarction caused by late stent thrombosis while under chronic aspirin therapy (Fig. 1). After thrombus aspiration, intravascular ultrasound and intravascular optical coherence tomography were performed showing incomplete coverage of 21% of the stent struts, which may reflect delayed vascular healing (Figs. 2 and 3).⇓⇓ Pathology of the thrombotic material showed a recent multilayered thrombus (Fig. 4). Post-procedure, the patient was treated with ReoPro (Centocor, Leiden, Netherlands) and was discharged with sustained aspirin and clopidogrel therapy.
The authors wish to thank Anne-Marie Maugenest and Sandy van Wunnik for their assistance.
- American College of Cardiology Foundation