Improved vascular healing after the successful treatment of very late sirolimus-eluting stent thrombosis with a bare metal stent implantation – A serial optical coherence tomography study

• Published in: Hellenic journal of cardiology 2016-03, Vol.57 (2), p.129-133
• Main Authors: Bouki, Konstantina P., Vlad, Delia, Riga, Maria, Stergiouli, Ifigenia, Toutouzas, Konstantinos P.
• Format: Article
• Language: English
• Subjects: Adult; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - etiology; Drug-Eluting Stents - adverse effects; Humans; Male; Non-ST Elevated Myocardial Infarction - etiology; Optical coherence tomography; Sirolimus - administration & dosage; Sirolimus eluting stent; Stent thrombosis; Stents; Tomography, Optical Coherence - methods; Treatment; Treatment Outcome
• ISSN: 1109-9666; 2241-5955
• DOI: 10.1016/j.hjc.2016.03.006

We present the case of a patient with non-ST-elevated myocardial infarction due to very late stent thrombosis 2 years after a sirolimus-eluting stent implantation (SES). Optical coherence tomography (OCT) imaging identified vessel wall destruction of the whole stented coronary segment with multiple cavity formations along the entire stent length, severe strut malapposition and thrombi. The patient was treated successfully with the implantation of a bare metal stent (BMS). Follow-up OCT imaging at 12 months revealed the improvement of vascular healing with complete re-endothelialization of the distal parts of the new BMS, while the stent body remained partly uncovered, suggesting vascular toxicity due to the old SES. The current case is the first to demonstrate the vascular response to a bare metal stent (BMS) implantation inside an old sirolimus-eluting stent with very late stent thrombosis in vivo using optical coherence tomography (OCT). Treatment of very late stent thrombosis with a new BMS resulted in a favourable outcome with improved vascular h ealing at 12 months, as identified by OCT.