Recurrence of late incomplete stent apposition after very late stent thrombosis following drug-eluting stent implantation.

A 48-year old man was admitted to our hospital because of chest pain 20 months after sirolimus-eluting stent implantation to his left anterior descending coronary artery. A coronary angiogram showed a thrombosis of the stented segment, which was successfully treated with bare-metal stent implantation. One month later, optical coherence tomography (OCT) demonstrated late-acquired incomplete stent apposition (ISA) in the stented segment. Additional dilatation was performed using a 4.5 mm balloon. Eleven months later, OCT and intravascular ultrasound images revealed recurrent ISA as a result of progressive vessel remodeling. Serial observation of the stented segment with late-acquired ISA is necessary to understand the natural course of late-acquired ISA and to establish a therapeutic strategy for late-acquired ISA after drug-eluting stent implantation.