Key result
Bare metal stent explanted at 9 years shows proteoglycan-dominated matrix suggesting organized thrombus.
Why the study?
No previous report has evaluated thrombosis occurring more than 9 years after bare metal stent implantation using multi-modality imaging and pathological assessment.
Case Report (n=1)
Very late bare metal stent thrombosis can occur up to 9 years post-implantation, characterized pathologically by a proteoglycan-dominated extracellular matrix suggesting an organized thrombus.
May warrant extended surveillance after BMS; leaves open mechanisms and optimal long-term antithrombotic strategies.
BACKGROUND: Late catch-up phenomenon following stent implantation is a well-known complication. However, no report has evaluated thrombosis after 9 years with multi-modality and pathological evaluation. CASE SUMMARY: A 71-year-old man with stable angina underwent elective percutaneous intervention of the left main coronary artery with implantation of a bare metal stent (BMS) 9 years ago. At the 9-year follow-up, coronary computed tomography (CCT) and coronary angiography (CAG) findings revealed a thrombus-like structure in the BMS slightly protruding into the sinus of Valsalva. Therefore, the previously prescribed double-antiplatelet therapy was replaced with an anticoagulant and clopidogrel, and a potent statin treatment was initiated. After the changes in drug treatment, follow-up examinations with CCT at 1 and 3 months suggested a decrease in the size of the thrombus; however, it appeared to increase after 6 months. Subsequently, the patient underwent surgical intervention. Pathological assessment of the explanted stent showed a proteoglycan-dominated extracellular matrix with few smooth muscle cells suggesting an organized thrombus. DISCUSSION: It should be emphasized that multiple factors might be responsible for very late stent thrombosis, such as peri-stent strut chronic inflammation involving proteoglycans, stent protrusion, and poorly controlled type 2 diabetes mellitus, possibly further inducing inflammatory cells.
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Yuki et al. (2021) conducted a case report in Very late bare metal stent thrombosis (n=1). Surgical intervention and pathological assessment was evaluated on Pathological assessment of the explanted stent. Pathological assessment of an explanted bare metal stent 9 years post-implantation revealed a proteoglycan-dominated extracellular matrix with few smooth muscle cells, suggesting an organized thrombus.
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