Mechanisms of very late stent thrombosis after drug-eluting stent implantation: findings from coronary angioscopy and optical coherence tomography.

D R U G E L U T I N G S T E N T S ( D E S ) A R E N O W W I D E L Y U S E D F O R P A T I E N T S W I T H C O R O N A R Y A R T E R Y D I S E A S E U N D E R G O I N G P E R C U T A N E O U S C O R O N A R Y I N T E R V E N T I O N S . A current major concern of using DES is very late stent thrombosis (VLST) that may occur beyond 1 year after DES implantation (1). VLST is an infrequent, albeit catastrophic complication, which can lead to myocardial infarction or sudden cardiac death (2). However, the underlying mechanisms of VLST remain unclear. In the current report, we show 3 cases of VLST after sirolimus-eluting stent (SES) implantation. Findings from coronary angioscopy (CAS) and optical coherence tomography (OCT) suggested 3 differential mechanisms of VLST in each case.