A case of very late stent thrombosis after sirolimus-eluting stent implantation in a patient with provoked severe coronary spasm

A 73-year-old male patient suffered from very late stent thrombosis occurred 6 years after sirolimuseluting stent (SES) implantation in the ostial and proximal left anterior descending coronary artery (LAD). He presented emergently with cardiogenic shock and emergent coronary angiography showed thombus in the ostial stent and in the ostial left circumflex artery. Optical coherence tomography found delayed healing on the ostial stent. Acetylcholine provocation test had also shown severe provoked coronary spasm in all coronary arteries 28 months after SES implantation which suggested the association of severe coronary endothelial dysfunction as a potential mechanism of very late stent thrombosis.