Stent thrombosis four and a half years after implantation of a sirolimus-eluting stent

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Drug-eluting stents (DES) are widely used to treat coronary artery disease.
• Sirolimus-eluting stents (SES) have demonstrated efficacy in reducing restenosis.
• The optimal duration of antiplatelet therapy after SES implantation remains a subject of research.

Observation:

• A case of very late stent thrombosis (VLST) is presented.
• Thrombosis occurred 51 months after SES implantation.
• The patient had discontinued clopidogrel (an antiplatelet medication) 15 months prior to the event.

Findings:

• VLST can occur long after SES implantation, even after cessation of antiplatelet therapy.
• The specific characteristics of SES may influence long-term thrombotic risk.
• This case highlights a potential failure of standard antiplatelet duration protocols.

Implications:

• Consideration for extended antiplatelet therapy beyond current guidelines in select patients receiving SES.
• Further research is warranted to identify risk factors for VLST after SES.
• This case may inform future clinical practice guidelines regarding antiplatelet therapy duration post-SES.