Circulation: Cardiovascular Interventions Editors’ Picks

Very late stent thrombosis occurs in patients with bare metal stent implantation, although the annual incidence is much lower than that after drug-eluting stent implantation. In-stent neoatherosclerosis with ruptured plaques and thin-cap fibroatheromas has been observed in bare metal stents. Atherosclerotic plaques harvested from patients with very late stent thrombosis and those with acute coronary syndrome unrelated to stent thrombosis were histologically indistinguishable from each other; showing foamy macrophages, cholesterol crystals, and thin fibrous cap. Disruption of neoatherosclerosis inside the stents could be an important underlying mechanism of very late stent thrombosis beyond 3 years after bare metal stent implantation.