Late stent thrombosis after paclitaxel-eluting stent implantation

Drug-eluting stents are widely used in the treatment of coronary artery disease, but late stent thrombosis is still a concern. A 54-year-old male patient who presented with unstable angina pectoris underwent paclitaxel-eluting stent implantation for 90% stenosis in the right coronary artery (RCA). He was asymptomatic during follow-up and clopidogrel was discontinued 13 months after the procedure. However, 17 months after stent implantation he presented with acute inferior myocardial infarction. Coronary angiography revealed total in-stent thrombosis in the RCA. Thrombotic occlusion was easily passed with a floppy guide wire and balloon angioplasty was successful resulting in TIMI II-III flow. The patient was asymptomatic during hospital stay and was discharged on appropriate medications.