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A 76-year-old male presented to hospital with an acute inferior ST elevation myocardial infarction. He had previously undergone percutaneous coronary intervention to his proximal and mid right coronary artery 6 years prior with 2 drug eluting stents (Xience V 3.5 × 15 mm and 2.75 × 15 mm; Abbott Vascular). Urgent coronary angiogram revealed a thrombotic total occlusion of the proximal RCA, within the previously deployed stent (Fig. 1) . Initially manual thrombectomy (Medtronic Export Aspiration System) was performed with restoration of TIMI III fl ow. Optical coherence tomography (OCT) imaging (St Jude Medical Dragonfl y) was per-

A new lesion in an old stent: A new insight into very late stent thrombosis