Late Stent Thrombosis After Biodegradable Polymer Everolimus-Eluting Stent in a Cancer Patient Receiving Bevacizumab

The biodegradable polymer everolimus-eluting stent (EES) aims to enhance vascular healing by avoiding durable polymer exposure, but its safety in cancer patients remains uncertain.

A 78-year-old man with gastric and hepatocellular carcinoma underwent percutaneous coronary intervention with implantation of a biodegradable polymer EES in the right coronary artery for acute myocardial infarction, followed by dual antiplatelet therapy. After cancer surgery, he received bevacizumab, an anti-vascular endothelial growth factor (VEGF) agent, as well as atezolizumab. On day 199 after stenting, 14 days after his second chemotherapy cycle, he died of sudden cardiac arrest. Autopsy revealed thrombotic occlusion of the stented segment, and histology showed complete re-endothelialization with abundant fibrin around the stent struts, expressing plasminogen activator inhibitor-1 with macrophages.

This case illustrates late stent thrombosis despite complete re-endothelialization on the biodegradable polymer EES, suggesting that both the patient's cancer-related prothrombotic state and his anti-VEGF therapy may have overcome the theoretical safety advantage of the stent.