Simultaneous very late stent thrombosis in multiple coronary arteries

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• First-generation sirolimus-eluting stents were implanted in 2005-2006 for multivessel percutaneous coronary intervention.
• Very late stent thrombosis (VLST) is a rare but serious complication following drug-eluting stent (DES) implantation.
• ST-segment-elevation myocardial infarction (STEMI) is a critical presentation of acute coronary syndrome.

Observation:

• Two female patients with prior multivessel DES implantation presented with STEMI due to VLST.
• One patient underwent successful repeat multivessel percutaneous coronary intervention, while the other received balloon angioplasty.
• Both patients were advised on smoking cessation and lifelong dual antiplatelet therapy (DAPT).

Findings:

• These cases suggest potential issues with first-generation DES and long-term stent patency.
• The varied presentations of VLST underscore the complexity of its management.
• The current literature review supports the need for further investigation into VLST.

Implications:

• The findings prompt a re-evaluation of the recommended duration of DAPT after DES implantation.
• Consideration should be given to adding an "extremely late stent thrombosis" category to the Academic Research Consortium classification for events occurring beyond 5 years.
• Further research is needed to optimize antiplatelet strategies and improve long-term outcomes for patients with DES.