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OCT Finding of Very Late Thrombosis after Stenting of Sirolimus-Eluting Stent
- Operator: Buxing Chen. MD
Relevant clinical history and physical exam

A 44-year old man was transferred to our hospital after thrombolytic therapy due to acute anterior wall myocardial infarction. He had a history of stenting due to unstable angina at proximal LAD with 3.0 *28 mm sirolimus –eluting stent (Cypher, Cordis, Johnson & Johnson) (Figure 1) 26 months ago. After stenting, he continued on clopidogrel and aspirin for 9 months. Thereafter, he discontinued clopidogrel and continued aspirin monotherapy. 24 months after stenting, he underwent angiographic surveillance. The follow-up angiogram showed irregular lumen without restenosis in stented segment (Figure 2). After tranferred to our hospital for management of post-myocaridal infarction, he underwent facilitated angiogram which showed the similar outcomes to 24 months follow up angiogram. He was a 20 pack-year smoker with hypertension and family history of coronary artery disease.

Relevant test results prior to catheterization
The ECG showed ST segment elevation with T-wave inversion in lead V2-5.
The ejection fraction was 40% with regional wall motion abnormalitiy of LAD territory.
Relevant catheterization and OCT findings
Facilitated coronary angiogram showed diffuse irregular narrowing of proximal to mid LAD (Figure 3). Rt.coronary angiogram showed normal.
Intracoronary optical coherence tomography(OCT) was used to examine the stent of LAD. The OCT images showed irregular stent strut separation, stent malapposition, fibrin-rich thrombus surrounding the surface of stent struts and dilated coronary artery in stented segment (Figure 4)
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