[Very late thrombosis of a drug-eluting stent presenting during the operation]

We report a case of very late thrombosis of sirolimus-eluting stent 38 months after implantation of a drug-eluting stent. An 81-year-old woman was suffering from acute cholecystitis and cholelithiasis and laparoscopic cholecystectomy was scheduled. Seven days before the operation, the patient's aspirin was replaced with heparin injection, which was discontinued 4 hours before the operation. During the operation we noticed ST-segment elevation on the monitor. An urgent coronary angiography was performed immediately after the operation, and stent thrombosis was found. Removal of the thrombosis and plain old balloon angioplasty was performed. We should exercise extreme caution for patients undergoing operation after implantation of DES quite a long time ago. We should have concrete guidelines for the treatment of DES patients in the perioperative period.