Optical coherence tomographic insights of very late stent thrombosis of a second-generation drug-eluting stent: a case report. Issue 12 (30th November 2021)

• Record Type: Journal Article
• Authors: Otaal, Parminder Singh; Gawalkar, Atit A; Shunmugarajan, Ajay
• Editors: Nagpal, Prashant; Borovac, Josip Andelo; Cankovic, Milenko Zoran; El Tahlawi, Mohammad; Ngo, Linh; Ahmed, Nida
• Is Part Of: European heart journal. Volume 5:Issue 12(2021)
• Publication Date: 2021-11-30
• Subjects: Very-very late stent thrombosis -- Second generations stent -- Optical coherence tomographic -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab490
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Very-very late stent thrombosis (VVLST) occurring more than 5 years after implantation of drug-eluting stent (DES) is extremely rare, being restricted to few case reports. Mainly described with first-generation stents, this life-threatening complication has not been described with later-generation stents. We describe the first case of VVLST occurring 3309 days (>9 years) after implantation of second-generation DES. Case summary: A 62-year-old man presented with the acute coronary syndrome. He has a history of percutaneous coronary intervention (PCI) to the right coronary artery using the three second-generation DES more than 9 years ago. Coronary angiogram revealed in-stent restenosis (ISR) with doubtful angiographic thrombus. Optical coherence tomography (OCT) confirmed the diagnosis of stent thrombosis (STh) localized to the stent overlap zone with underlying ISR. Patient underwent OCT-guided PCI with DES implantation and was discharged on dual antiplatelet therapy including ticagrelor. He is doing well on follow-up at 6 months. Discussion: Stent thrombosis can occur in second-generation stents nearly a decade after implant. Stent overlap segment is more prone to neo-atheroma formation and vulnerable plaque leading to STh. In addition to confirming the diagnosis, OCT provides exciting insights into the underlying mechanism. This has implications for long-term antiplatelet therapy in patients implanted with multiple stents.