Although very late
stent thrombosis after
drug-eluting stent implantation is a critical event, its cause has not been clarified. This is the first report of a case with very late
stent thrombosis after
drug-eluting stent implantation for which prior angioscopic image of the culprit lesion is available. A 54-year-old Japanese male patient with
stable angina who received implantation of
sirolimus-eluting
stent at the culprit lesion and 1-year follow-up angiographic and angioscopic examinations came back with
chest pain at rest at 2.5 years after the
stent implantation. Very late
stent thrombosis was diagnosed by emergent angiographic and angioscopic examinations and was treated by
zotarolimus-eluting
stent. One-year angiographic and angioscopic follow-up examinations after
zotarolimus-eluting
stent were performed. Angioscopy revealed uncovered
stent strut, yellow plaques, and
thrombus at 1-year follow-up after
sirolimus-eluting
stent implantation, and it confirmed the thrombotic occlusion inside the
sirolimus-eluting
stent at the time of emergent catheterization. This is a case of very late
stent thrombosis in the
drug-eluting stent where uncovered
stent strut, yellow plaques, and
thrombus had been detected by angioscopy 1.5 years before the onset. Those thrombogenic sources might be the cause of
stent thrombosis.