Very late stent thrombosis: simultaneous two-arterial occlusions

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Drug-eluting stents (DES) are widely used to prevent restenosis after percutaneous coronary intervention.
• Cypher stents, a type of sirolimus-eluting stent, have been associated with late stent thrombosis in some cases.
• Very late stent thrombosis (VLST) is a rare but serious complication occurring >1 year after stent implantation.

Observation:

• A patient presented with a massive acute myocardial infarction and cardiogenic shock.
• Diagnostic workup revealed very late dual Cypher stent thrombosis as the cause.
• The patient had no prior history of stent thrombosis or adverse events.

Findings:

• VLST in dual Cypher stent configurations is an uncommon clinical scenario.
• Massive myocardial infarction and cardiogenic shock were directly attributed to the thrombotic event.
• Successful management involved emergent resuscitation and prompt angioplasty.

Implications:

• This case highlights the potential for rare thrombotic complications even with established DES.
• Vigilance for VLST is crucial in patients with a history of Cypher stent implantation.
• Timely intervention with angioplasty is critical for managing acute myocardial infarction secondary to VLST.