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

Saloni Jain; Noreen Syed; Jorge Naranjo; Michael S Huang; Ashok Chaudhary

doi:10.1016/j.jaccas.2025.103871

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

JACC Case Rep. 2025 Jun 25;30(16):103871. doi: 10.1016/j.jaccas.2025.103871.

Authors

Saloni Jain¹, Noreen Syed², Jorge Naranjo², Michael S Huang², Ashok Chaudhary³

Affiliations

¹ Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
² Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
³ Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. Electronic address: Dr.ashokchaudhary@gmail.com.

PMID: 40579084
DOI: 10.1016/j.jaccas.2025.103871

Abstract

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.

Keywords: coronary angiography; imaging; intravascular ultrasound; myocardial infarction; percutaneous coronary intervention.

Publication types

Case Reports