Very late drug-eluting stent thrombosis related to incomplete stent endothelialization: in-vivo demonstration by optical coherence tomography.

Very late drug-eluting stent (DES) thrombosis is a rare but potentially life-threatening event that has become a major cause of concern. Delayed arterial healing with incomplete endothelialization is probably a pivotal factor related with DES thrombosis. Optical coherence tomography (OCT) is a new high-resolution intracoronary imaging technique that allows detailed evaluation of stent neointimal coverage. We present a case of very late DES thrombosis that was evaluated with OCT, demonstrating incomplete endothelialization as the probable main mechanism of stent thrombosis. This case illustrates the ability of OCT for in-vivo identification of stent coverage and its potential role in the evaluation of stent thrombosis mechanisms.