Journal of Invasive Cardiology

FULL TITLE: Very Late Thrombosis After Subintimal Sirolimus-Eluting Stent Implantation During Percutaneous Coronary Intervention for Chronic Total Occlusion

ABSTRACT: The clinical significance of late-acquired incomplete stent apposition (ISA) after drug-eluting stent (DES) implantation remains controversial. In a case report, late-acquired ISA occurred after a DES was implanted into the subintimal space during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, to our knowledge, there is no report of very late thrombosis of such a case. The present case report describes a late-acquired ISA occurring in the true lumen side external to the subintimally located sirolimus-eluting stent implanted during PCI for a CTO, resulting in very late stent thrombosis (VLST). The late-acquired ISA was observed by intravascular ultrasound and optical coherence tomography at the time of follow-up angiography after VLST.

J INVASIVE CARDIOL 2010;22:E162–E165

________________________________________________________

Very late thrombosis after drug-eluting stent (DES) implantation has emerged as an important late complication of percutaneous coronary intervention (PCI). Late stent thrombosis beyond 12 months occurs more frequently with DES than with bare-metal stents.¹ Although the clinical significance of late-acquired incomplete stent apposition (ISA) after DES implantation remains controversial, intravascular ultrasound (IVUS) examination of late DES thrombosis often shows ISA at the time of the event. A significant gap between struts and vessel wall or aneurysm formation might reduce local blood flow that promotes platelet adhesion and the coagulation cascade.² We present a case in which late-acquired ISA occurred in the true lumen side external to a subintimally located sirolimus-eluting stent (SES) implanted during PCI for chronic total occlusion (CTO), resulting in very late stent thrombosis (VLST).