Late stent thrombosis: the last remaining obstacle in coronary interventional therapy

Drug-eluting stents (DES) represent an outstanding improvement in the interventional cardiology field. DES have markedly decreased stent restenosis and the clinical need for repeat revascularization, without increasing mortality, compared to bare-metal stents (BMS). However, the widespread use of DES has raised concerns regarding the occurrence of late stent thrombosis (ST), beyond the traditional 1-month timeframe in which thrombotic events were found to occur after BMS implantation. While early ST (events occurring within 1 month after stent placement) has been shown to be similar between DES and BMS, late (events occurring after 1 month following stent implantation) and very late (events occurring more than 1 year following stent implantation) ST have emerged as distinct major pitfalls of DES implantation. In this review we describe the current knowledge regarding late and very late ST after DES implantation.