Delayed Stent Thrombosis

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Delayed Stent Thrombosis

• 41F with prior h/o HTN, dyslipidemia, CAD,
  presents with recurrent rest angina.
• Past cardiac history notable for anterior MI in
  2003, treated with stenting of LAD with DES.
• Represented in 8/2005 with rest angina and TnI of
  1.4, and angiography notable for thrombotic,
  occluded LAD stent. Mid LAD disease was noted
  upon PTCA of proximal LAD, and IVUS showed mild
  underexpansion of prior stent and moderate
  neointimal proliferation.
• Two additional Cypher stents were placed (3.0 x
  33 mm proximally and 2.5 x 18 mm in mid LAD

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Patient J.D

• She presents in 8/06 with recurrent rest angina
  and TnI of 4.2.
• Of note, she had discontinued clopidogrel 2
  months prior to presentation due to menstrual
  bleeding.
• IVUS showed good stent expansion, moderate
  neointimal proliferation, and thrombus.
  Furthermore, advanced proximal disease was noted.

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Well-apposed stents
Severe proximal LAD dz
Moderate ISR
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Angiojet
Improved after angiojet
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Final result
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Take Home Points

• Delay stent thrombosis is a rare but important
  complication following DES placement
• Secondary causes for delayed stent thrombosis
  include proximal or distal disease, incomplete
  stent apposition, or discontinuation of
  antiplatelet therapy
• Optimal duration of antiplatelet therapy is not
  known