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The incidence of late stent thrombosis after successful cypher stent implantation

Author(s): Amir Aslani | MB Sharifkazemi | M Zamirian

Journal: Iranian Cardiovascular Research Journal
ISSN 1735-885X

Volume: 1;
Issue: 2;
Start page: 103;
Date: 2007;
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Keywords: Sirolimus eluting stent | Stent | Thrombosis

Background: Stent thrombosis is a rare but devastating complication ofcoronary stent implantation. Coronary stent deployment is associated with a lowincidence of acute and sub-acute thrombosis. However, late stent thrombosis hasbeen recognized clinically. The aim of this prospective study was to evaluatethe incidence of late stent thrombosis in patients receiving sirolimus-elutingstents.Patients and Methods: One hundred patients (132 lesions) who underwentimplantation of sirolimus eluting stents were selected. All patients werepre-medicated with 325 mg of aspirin, which was continued indefinitely.Anti-thrombotic regimens, including intravenous heparin and a loading dose ofclopidogrel (300 mg) were given in the catheterization laboratory andclopidogrel 75 mg/day was continued for at least 6 months. In patients allergicto clopidogrel, ticlopidine at a dose of 250 mg twice daily was prescribed as asubstitute. Late stent thrombosis was defined as myocardial infarctioncharacterized by anginal symptoms with ST-elevation on the electrocardiogram andcreatine kinase-MB elevation >3 times the upper limit of normal withangiographic documentation of partial or total stent occlusion more than 30 daysafter sirolimus eluting stent implantation (while the stented segment was theculprit lesion).Results: Complete 2 year follow-up was available for all patients.Between 30 days to 2 years after sirolimus-eluting stent implantation, 2patients (2%) experienced late stent thrombosis at a mean time of 420 days(range 360 to 480).Conclusions: This study reports a very late stent thrombosis after 20months of sirolimus eluting stent implantation and 15 months after cessation ofclopidogrel treatment, despite continued aspirin administration. This study alsoimplies the possible need for long term antiplatelet therapy among patientsreceiving sirolimus eluting stents.

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