Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement

Figure 4

A case of grade V stent fracture: SES and PES. A 68 year-old woman died suddenly from stent thrombosis in left circumflex artery (LCX) 172 days following stent implantation. Radiograph showing the stented LCX and left obtuse marginal artery (LOM) (a). Note, presence of grade V sirolimus-eluting stent (SES) fracture highlighted in magnified image (i) and another grade V fracture at the bifurcation site in the paclitaxel-eluting stent (PES) (ii). SES in LOM with grade V fracture was associated with restenosis (b). PES fracture in LCX was located in the area close to the bifurcation site where the thrombus was located (Thr). The stented LCX segment distal to the fracture was widely patent (d). (Reproduced with permission from [46].)