Late thrombosis of a drug-eluting stent presenting in the perioperative period.

DRUG-ELUTING stents (DES) represent the latest percutaneous coronary intervention (PCI) designed to deal with the problem of in-stent restenosis. These stents are impregnated with a drug (sirolimus or paclitaxel) that retards the neointimal proliferation that leads to restenosis. The thrombogenic profile of DES differs from that of bare metal stents. Postprocedure dual antiplatelet therapy (clopidogrel and aspirin) is required for all types of stents. The recommended duration is 1 month for bare metal stents, 3 months for sirolimus DES, and 6 months for paclitaxel DES. Patients are then maintained on lifelong aspirin. Stent thrombosis is described as acute, subacute, or late ( 30 days). An emerging phenomenon is the observation that DES may carry a higher risk of late stent thrombosis. We report a case of perioperative very late stent thrombosis occurring in a patient with a DES.