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Stent thrombosis (ST) is a rare but potentially fatal complication of percutaneous treatment of coronary artery disease. According to the Academic Research Consortium criteria and classification, ST can occur either acutely (within 24 h), subacutely (within 1-30 days), late (within 1-12 months), or very late (beyond 1 year) after stent implantation (1). The use of a new term “extremely late stent thrombosis ” was suggested for cases of stent thrombosis that occur ≥5 years after stent implantation (2). Very late stent thrombosis (VLST) occurs more frequently with first-generation DES than with BMS, and the majority of VLST occur within 1-4 years of stent implantation. VLST is extremely rare after 5 years of stent implantation, with the first case being reported in 2009 (3). Few cases have been reported since 2009 until now. The longest reported intervening period between stent implantation and acute coronary event secondary to stent thrombosis is 11 years (4). The underlying pathophysiology of VLST is not completely understood and because duration of dual antiplatelet therapy is undetermined. Here we report the first case of an extremely late stent thrombosis presenting as a nonST-elevation myocardial infarction (NSTEMI) from Turkey, which occurred 2691 days after implantation of a first-generation DES and 3 months after discontinuation of clopidogrel therapy.

Extremely late stent thrombosis after more than 7 years (2691 days) of sirolimus-eluting stent implantation