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A 49-year-old woman presented with sudden onset chest pain, at rest, evident of ST-segment elevation in the anterior leads of a 12-lead electrocardiogram. She received stent implantation with a 3.5 × 23 mm sirolimus-eluting stent at the proximal portion of left anterior descending artery (LAD) 10 years ago. Dual antiplatelet therapy, however, was discontinued 3 years ago. Urgent coronary angiography demonstrated a near total occlusion at the proximal portion of LAD, which was the same segment of the previous stent implantation (Fig. 1A). Optical coherence tomography (Supplementary

Very late stent thrombosis derived from thin-cap neoatheroma and fibroatheroma with plaque rupture assessed by optical coherence tomography