Late angiographic stent thrombosis of polymer based paclitaxel eluting stent

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Abstract
Patient 1 was a 44 year old man who underwent percutaneous coronary stent implantation for evolved myocardial infarction in September 2002. A 3.0 mm (diameter) × 24 mm (length) Taxus stent was implanted in the proximal left anterior descending coronary artery (LAD). Treatment for six months with aspirin (100 mg/day) and clopidogrel (75 mg/day), followed by life long aspirin (100 mg/day), was recommended. The patient was compliant with antiplatelet treatment but continued to smoke. He remained well until 13 months later when he was readmitted with acute anterior myocardial infarction. Emergency coronary angiography showed a totally occluded proximal LAD at the site of the previously implanted Taxus stent. Intravascular ultrasound (IVUS) showed only mild in-stent neointimal hyperplasia, suggesting primarily a thrombotic event. The stent was well expanded except for a small segment at the proximal stent edge. No stent malapposition or edge stenosis was noted. Balloon dilatation was performed with the elective use of eptifibatide. The patient made an uneventful recovery and was discharged four days after the procedure.