Very late stent thrombosis and antineoplastic therapy

Percutaneous coronary intervention (PCI) is now a part of the treatment strategy of patients with both unstable syndromes and chronic angina. As our patients age and live longer with coronary artery disease, many having had PCI, they are more likely to develop potentially life-threatening comorbid conditions, including neoplastic disorders. In the United States, for example, an estimated 41% of the population will develop some form of malignancy.1 As such, they become subject to a multitude of interactions between their cardiac and oncologic diseases, and the therapies used to treat each. This is especially the case when patients have had PCI with drug-eluting stents (DES), as a careful balance between thrombosis and bleeding must be maintained, and is particularly vulnerable to the interactions described above. The following cases and accompanying review will highlight potential risks of very late stent thrombosis with acquired prothrombotic states, following coronary intervention with implantation of both 1st and second-generation DES.