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Simultaneous very late stent thrombosis in multiple coronary arteries

Seshasayee Narasimhan1, Nassim Rostane Krim, Gary Silverman

  • 1Department of Medicine, Cardiovascular Division, Montefiore-Einstein Heart Center, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York 10461, USA. docsesh@gmail.com

Texas Heart Institute Journal
|October 31, 2012
PubMed

Insights

Two cases of very late stent thrombosis highlight the need to reconsider lifelong dual antiplatelet therapy after drug-eluting stent implantation and potentially redefine "extremely late stent thrombosis".

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.

Keywords:
AspirinST-elevation myocardial infarctionclopidogrelcoronary restenosis/etiologycoronary thrombosis/etiologydrug delivery systems/adverse effectsimmunosuppressive agentspaclitaxelplatelet aggregation inhibitors/therapeutic usesirolimus/therapeutic usestent thrombosisstents, drug-eluting/adverse effectsvery late stent thrombosis

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