Very late stent thrombosis at 2.5 years after sirolimus-eluting stent implantation with prior angioscopic image of culprit lesion: A case report.

Although very late stent thrombosis after drug-eluting stent implantation is a critical event, its cause has not been clarified. This is the first report of a case with very late stent thrombosis after drug-eluting stent implantation for which prior angioscopic image of the culprit lesion is available. A 54-year-old Japanese male patient with stable angina who received implantation of sirolimus-eluting stent at the culprit lesion and 1-year follow-up angiographic and angioscopic examinations came back with chest pain at rest at 2.5 years after the stent implantation. Very late stent thrombosis was diagnosed by emergent angiographic and angioscopic examinations and was treated by zotarolimus-eluting stent. One-year angiographic and angioscopic follow-up examinations after zotarolimus-eluting stent were performed. Angioscopy revealed uncovered stent strut, yellow plaques, and thrombus at 1-year follow-up after sirolimus-eluting stent implantation, and it confirmed the thrombotic occlusion inside the sirolimus-eluting stent at the time of emergent catheterization. This is a case of very late stent thrombosis in the drug-eluting stent where uncovered stent strut, yellow plaques, and thrombus had been detected by angioscopy 1.5 years before the onset. Those thrombogenic sources might be the cause of stent thrombosis.