Histological confirmation of hypersensitivity as a contributor to very-late coronary stent thrombosis

Simultaneous Multi-Vessel Very Late Stent Thrombosis in Acute ST-Segment Elevation Myocardial Infarction

“…It usually presents as acute STEMI, but compared to patients with early and late ST, patients with VLST had better prognosis with lower incidence of major adverse cardiac events and mortality [6][7][8]. The mechanism of VLST is not fully understood, but is thought to be related to delayed incomplete stent strut endothelialization [9,10], stent strut malapposition secondary to positive remodeling [10,11], stent fracture [12], hypersensitivity reaction to polymers [13,14], chronic inflammation [9,15], rupture of lipid-laden-like neointima within the DES [10], and discontinuation of antiplatelet therapy [16]. In our case, we did not notice anything from his medical history that known to contribute to VLST, and there was no delay in patient transfer or patient care.…”

An Unusual Presentation of Allergic Reactions: Kounis Syndrome

“…So far, cases with Kounis syndrome presenting with ST elevation myocardial infarction (STEMI) and coronary stent thrombosis have been reported. 4,8 The overall prognosis of the disease is favourable, most of the cases being asymptomatic at long term under antihistaminic therapy. The allergenic triggers include both topical and food allergy.…”

“…First described by Kounis et al as "the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult", 1 it has been increasingly recognised as a potential cause of angina pectoris, 2 acute coronary syndromes, 3 and possibly stent thrombosis. 4 We describe here a case with allergic reaction associated with ST elevation in electrocardiogram (ECG) and near-normal coronary arteries on coronary angiography.…”

Super late stent thrombosis occurred at 8 years after drug-eluting stent implantation

“…However, it is not clear whether late stent thrombosis risk diminishes with time during the further period of follow-up. In several literatures, very late stent thrombosis has been reported up to 6 years after DES implantation [3][4][5]. We reported this case with stent thrombosis 8 years after implantation of a PES and called it "super late stent thrombosis".…”