Sirolimus
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Very late stent thrombosis following aspirin withdrawal in an elderly patient: case report An about 67-year-old man, who had undergone implantation of sirolimus-eluting stents [Cypher; dosages not stated], experienced very late stent thrombosis with associated stent fractures and peri-stent aneurysms after he discontinued aspirin therapy. The man underwent percutaneous intervention (PCI) with stent implantation for total occlusion of his proximal left anterior descending artery (LAD) in February 2004, aged 64 years. Significant stenosis of his mid-LAD bifurcation was noted 6 months later, and a 3.0 × 33mm sirolimus-eluting stent was deployed, followed by dilation of a lesion in his second diagonal (D2) LAD branch. That night, examination due to severe chest pain revealed a compromised D2; a second, 2.5 × 23mm sirolimus-eluting stent was deployed and ballooned into the LAD. Mild peri-stent aneurysm formation in his mid-LAD was observed in March 2005; he was asymptomatic and therapy included aspirin 200 mg/day. During a hospital stay in June 2007, 35 months after stenting, he interrupted aspirin therapy for 3 days, and developed severe squeezing chest pain the following day. At an emergency room, an ECG showed a tall T wave in his anterior wall, and coronary angiography revealed massive thrombosis with total occlusion of both sirolimus-eluting stents in the midLAD and D2; peri-stent aneurysmal dilation and 5-segment stent strut fractures were also observed. The man received IV tenecteplase and low-molecularweight heparin. His regional wall motion abnormality had recovered on follow-up echocardiography 4 days later, and repeat angiography revealed complete resolution of thrombi 12 days after thrombolysis. His recovery was uneventful, and his medication included aspirin and clopidogrel on discharge. Lee S-E, et al. Very late stent thrombosis associated with multiple stent fractures and peri-stent aneurysm formation after siriolimus-eluting stent implantation. 801117030 Circulation Journal 72: 1201-1204, No. 7, Jul 2008 - South Korea
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Reactions 12 Jul 2008 No. 1210
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