Implantation of a bare metal stent for very late sirolimus-eluting stent thrombosis may improve vascular healing, though partial uncoverage can persist.
Very late SES thrombosis with OCT-documented vessel destruction and malapposition may occur; this Level 5 case leaves open optimal surveillance and therapy.
We present the case of a patient with non-ST-elevated myocardial infarction due to very late stent thrombosis 2 years after a sirolimus-eluting stent implantation (SES). Optical coherence tomography (OCT) imaging identified vessel wall destruction of the whole stented coronary segment with multiple cavity formations along the entire stent length, severe strut malapposition and thrombi. The patient was treated successfully with the implantation of a bare metal stent (BMS). Follow-up OCT imaging at 12 months revealed the improvement of vascular healing with complete re-endothelialization of the distal parts of the new BMS, while the stent body remained partly uncovered, suggesting vascular toxicity due to the old SES.
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Bouki et al. (2016) studied this question.
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