A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography

Drug-eluting stent (DES) thrombosis remains a rare but feared complication in patients undergoing coronary interventions. Mechanical factors (stent underexpansion, malapposition, inflow-outflow disease, residual dissections) have been suggested to play a potential role in this setting.1,2 These predisposing problems can be readily identified with the use of intravascular ultrasound or optical coherence tomography (OCT).1–4 Furthermore, lack of complete endothelialization appears to be implicated in cases with very late DES thrombosis, in which OCT might allow a more precise diagnosis.3,4 We present a patient with very late DES thrombosis in whom OCT unraveled a unique, previously unreported, underlying mechanism.A 49-year-old man with a large anterior myocardial infarction was referred to our center for rescue angioplasty after failed thrombolysis. Six years previously, he presented with unstable angina and coronary angiography revealed a severe lesion in the proximal left anterior descending coronary artery (LAD), …