Recurrent very late thrombosis of drug-eluting stent: Optical coherence tomography findings

Very late stent thrombosis (VLST) after implantation of a drug-eluting stent (DES) is a rare but catastrophic complication and the mechanisms are not completely understood. We describe a 76-year-old patient with recurrent VLST of DES that developed at 13 and 23 months after the initial catheter procedure of DES implantation under the cessation of dual antiplatelet therapy. Optical coherence tomography (OCT) observation revealed small stent area of a DES. Based on the OCT findings, balloon angioplasty for expansion of the DES was performed and angiographic Thrombolysis In Myocardial Infarction grade 3 flow was subsequently obtained. Small stent area is considered a significant factor in acute or subacute stent thrombosis according to previous reports. The present report shows that small stent area of DES may be regarded as a key factor in recurrent VLST as well as cessation of dual antiplatelet therapy.