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Updated: Jul 12, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
In-stent restenosis and thrombosis 41 months after drug-eluting stent implantation
Insights
Very late stent thrombosis can occur over a year after drug-eluting stent placement, even after clopidogrel discontinuation. Indefinite dual antiplatelet therapy is recommended to prevent recurrence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Drug-eluting stents (DES) are associated with a higher risk of very late stent thrombosis (>1 year) compared to bare metal stents (BMS) after antiplatelet therapy cessation.
- Current guidelines often recommend shorter durations of dual antiplatelet therapy (DAPT) after DES implantation.
Observation:
- An 83-year-old male experienced left anterior descending (LAD) in-stent thrombosis 41 months post-sirolimus-eluting stent (SES) implantation.
- Clopidogrel was discontinued at 6 months according to prevailing guidelines.
- Intracoronary ultrasound (ICUS) revealed significant in-stent restenosis causing a 1 mm lumen diameter narrowing.
Findings:
- The patient underwent successful aspiration of in-stent thrombus and subsequent stenting with a bare metal stent.
- No recurrence of stent thrombosis was observed during a one-month follow-up period.
Implications:
- This case highlights the potential for very late stent thrombosis in DES, extending beyond the typical >1 year timeframe.
- Indefinite dual antiplatelet therapy (aspirin and clopidogrel) may be warranted in select patients with DES to mitigate the risk of late stent thrombosis.
- Revisiting DAPT duration guidelines for DES may be necessary based on long-term clinical outcomes.
Abstract:
Evidence indicates that very late stent thrombosis (>1 year) occurs more frequently in drug-eluting stents than in bare metal stents after discontinuation of clopidogrel. We present a case of an 83 year old man with an LAD in-stent thrombosis 41 months after stenting with a sirolimus-eluting stent in whom clopidogrel was discontinued after 6 months based on these days' guidelines. In-stent thrombus was aspirated and intracoronary ultrasound (ICUS) showed significant in-stent restenosis which had narrowed the minimal lumen diameter by 1 mm. The lesion was stented with a bare metal stent. The patient was discharged after recovery and had no recurrence of stent thrombosis in one month follow-up. We recommended indefinite dual antiplatelet therapy with aspirin and clopidogrel.