Triple, simultaneous, very late coronary stent thrombosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Coronary artery stent thrombosis, particularly very late stent thrombosis (VLST), poses a significant safety concern for drug-eluting stents (DES).
• The exact pathophysiology and long-term management strategies for VLST remain incompletely understood.
• The safety profile of first-generation DES necessitates further investigation into long-term complications.

Observation:

• A rare instance of simultaneous very late DES thrombosis occurred across three distinct vascular territories.
• This catastrophic event followed the discontinuation of antiplatelet therapy seven years after the initial stent placement.
• The patient presented with acute cardiogenic shock as the primary clinical manifestation.

Findings:

• The case demonstrates a potential for simultaneous, multi-territorial VLST, even years after stent implantation.
• Discontinuation of dual antiplatelet therapy seven years post-DES placement was associated with this severe complication.
• The presentation underscores the critical role of sustained antiplatelet therapy in preventing late stent-related adverse events.

Implications:

• This case suggests that longer-term dual antiplatelet therapy may be crucial for mitigating the risk of VLST, even in the absence of immediate post-procedural complications.
• Further research is warranted to elucidate the precise mechanisms and identify predictors of very late DES thrombosis.
• Clinical guidelines may need re-evaluation regarding the optimal duration of antiplatelet therapy after DES implantation, especially for first-generation devices.