17 Years Not Too Late: A Case of Extremely Late Stent Thrombosis.

BACKGROUND

Stent thrombosis (ST) is a serious complication of percutaneous coronary intervention, portending to significant morbidity and mortality with a U-shaped relationship with increased mortality in early and very late ST.

CASE SUMMARY

The patient presented with an inferior wall ST-segment elevation myocardial infarction and was found to have ST of a prior drug-eluting stent (DES) 17 years postimplantation. Thrombus was confirmed during angiography and with intravascular ultrasound. It was treated with mechanical thrombectomy, balloon angioplasty, and a second layer of intravascular ultrasound-guided DES with excellent results.

DISCUSSION

This was a rare case of very, very late-presenting ST, which occurred 17 years after the index DES. This patient's risk factors include smoking and aspirin interruption. Possible mechanisms were neoatherosclerosis with plaque rupture and impaired re-endothelialization.

TAKE-HOME MESSAGE: Unpredictable, extremely late ST can still happen more than 15 years after an index DES. Intraprocedural multimodal imaging remains pivotal in intrastent lesion management.