Stent thrombosis is not always stent thrombosis: de novo atherosclerosis in a stented coronary segment.

We discuss a case of late thrombosis, 9 years after implantation of overlapping bare metal stents in a circumflex artery. The patient presented with an acute ST segment elevation infero-lateral myocardial infarction. The coronary angiogram revealed a sub-occlusive thrombus within the boundaries of the stents. Aspiration of the material was performed and pathological analysis showed, together with fibrin thrombus and platelet aggregates, fragments of an atherosclerotic plaque (parts of necrotic core with cholesterol clefts and inflammatory cells such as macrophages) including iron deposition, suggestive for plaque rupture. We conclude that this event occurred because of de novo atherosclerotic formation of a vulnerable, rupture-prone plaque within the boundaries of the stents.