Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent (original) (raw)
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Very very late stent thrombosis- An emerging predicament
Journal of Cardiology Case Reports, 2019
Very late stent thrombosis is a known entity in interventional cardiology. Previous literature has mentioned very late stent thrombosis as a complication associated with drug-eluting stents. We report the case of a 62-year-old man with Non-ST segment-elevation myocardial infarction 5 years after drug-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the most probable cause. 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 reported in India.
Bangladesh Heart Journal, 2021
Stent thrombosis is one of the gravest complications of percutaneous coronary intervention which usually manifest as ST-segment elevation myocardial infarction or sudden death. There are a very few case reports in the literature regarding extremely late stent thrombosis in a drug-eluting stent. Here we report a case of extremely late stent thrombosis in a first generation drug-eluting stent in a 54 year old gentleman. To the best of our knowledge, this is the first case report with the longest duration (10 years) after sirolimus eluting first-generation DES in Bangladesh. Bangladesh Heart Journal 2021; 36(2): 164-168
Analysis of 36 Reported Cases of Late Thrombosis in Drug-Eluting Stents Placed in Coronary Arteries
American Journal of Cardiology, 2007
Drug-eluting stents (DESs) have decreased the incidence of in-stent restenosis. Within the past 2 years several cases on late stent thrombosis (LST) have been reported. This study analyzed and reviewed all published cases of LST in DESs to explore possible trends not previously reported. We applied a Medline search using the key word "drug eluting stents." All 845 positive matches in March 2006 were screened for case reports of LST in DESs, defined as angiographic stent thrombosis >30 days after deployment. We included reported LSTs from randomized trials, observational registry reports, and letters to the editor if information regarding timing from stent deployment to clinical event, vessel, stent diameter and length, and antiplatelet regimen were available. There was no significant difference in the incidence of LST between sirolimus-and paclitaxel-eluting stents. Median time from stent deployment to clinical event was 242 days (total range 39 to 927). If aspirin and clopidogrel were discontinued, median time to clinical event was 7 days (3 to 150). In comparison, if only clopidogrel was discontinued, median time to clinical event was 30 days . There was no significant difference in stent diameter and length between sirolimus-and paclitaxel-eluting stents. Forty-two percent of events occurred in relation to a surgical procedure for which the 2 antiplatelet agents or clopidogrel alone was discontinued. In conclusion, there was a strong association between occurrence of LST and cessation of dual antiplatelet therapy. Patients who continued on aspirin had a significant delay to the clinical event. Efforts should be made to maintain patients on aspirin during routine surgical procedures.
Case Reports
Very late stent thrombosis is a rare complication of percutaneous coronary intervention in the era of dual antiplatelet therapy. The risk factors for stent thrombosis are drug default, age, diabetes, renal dysfunction, left ventricular dysfunction, smoking or procedure-related factors and complications. We are describing the case of a 55-year-old non-smoker patient without the conventional risk factors for stent thrombosis maintaining good compliance with dual antiplatelet (aspirin and clopidogrel) drugs in standard doses. The patient had a history of having received a Cypher stent more than 7 years (2634 days) ago in the left circumflex artery for the management of in-stent restenosis of a bare metal stent implanted previously. He was referred with acute stent thrombosis with an atypical presentation of non-ST elevation myocardial infarction having unexplainable spontaneous resolution of electrocardiographic changes. The patient was successfully managed with newer generation drug-e...
Drug-Eluting Coronary Stent Very Late Thrombosis Revisited
Herz Kardiovaskuläre Erkrankungen, 2008
Im Vergleich zu unbeschichteten Stents ("bare-metal stents" [BMS]) haben medikamentenbeschichtete Stents ("drug-eluting stents" [DES]) eine zusätzliche signifikante Reduktion der Häufigkeit von Restenosen und Reinterventionen ermöglicht. Gegenüber BMS ist jedoch das Risiko einer sehr späten Stentthrombose nach DES-Implantation grenzwertig höher und beträgt bis 3 Jahre und möglicherweise noch länger nach Implantation jährlich 0,2-0,6%. Risikoreduktionsstrategien umfassen eine sorgfältige Implantationstechnik, die Identifikation von Patienten mit erhöhtem Thrombosepotential, den Ausschluss von Patienten mit kurzfristig geplanten großen chirurgischen Eingriffen und eine duale antithrombotische Therapie für mindestens 12 Monate. Zukünftige Risikovermeidungsstrategien werden skizziert und kommentiert.
Stent Thrombosis in the Era of the Drug-Eluting Stent
Korean Circulation Journal, 2005
Coronary stent thrombosis (ST) has been regarded as a rare but catastrophic complication of bare-metal stent (BMS) implantation that normally occurs during the first few weeks after stenting. In the drug-eluting stent (DES) era, there has been increasing concern regarding higher rates of ST due to delayed endothelialization. However, a pooled meta-analysis of randomized clinical trials and registry studies showed rates of ST (0.4-1.5%) after DES to be similar to those of BMS. The rate of ST did not differ between sirolimus-and paclitaxel-eluting stents. Additionally, the rates of late ST were similar between DES and BMS. Remarkably, very late occurrence of ST, which develops up to 1-2 years after DES implantation, was significantly associated with complete cessation of antiplatelet therapy. Further large-scale studies are needed to determine the optimal combination and duration for antiplatelet therapy in order to prevent these serious thrombotic events.
Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy
Lancet, 2004
Although the safety profiles of coronary stents eluting sirolimus or paclitaxel do not seem to differ from those of bare metal stents in the short-to-medium term, concern has arisen about the potential for late stent thromboses related to delayed endothelialisation of the stent struts. We report four cases of angiographically-confirmed stent thrombosis that occurred late after elective implantation of polymer-based paxlitaxel-eluting (343 and 442 days) or sirolimus-eluting (335 and 375 days) stents, and resulted in myocardial infarction. All cases arose soon after antiplatelet therapy was interrupted. If confirmed in systematic long-term follow-up studies, our findings have potentially serious clinical implications.