Five Years on Dual-Antiplatelet Therapy

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  • Pennacchi Mauro
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”
  • Stio Rocco Edoardo
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”
  • Lucisano Luigi
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”
  • Calcagno Simone
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”
  • Mancone Massimo
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”
  • Sardella Gennaro
    Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “Sapienza”

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  • DES Thrombosis After Clopidogrel Withdrawal

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Description

Drug-eluting stents (DES) have a moderately higher incidence of stent thrombosis compared to bare metal stents (BMS) and very late DES thrombosis has been frequently described. We report a case of a 66 year-old male who experienced very late stent thrombosis at 5 years after paclitaxel-eluting stent (PES) implantation and 3 days after clopidogrel withdrawal. Intravascular ultrasound (IVUS) performed during the index procedure showed that the previously implanted PES was undersized. Since the patient could not take clopidogrel, we treated him with only a noncompliant balloon (3.0 × 15 mm) with optimal expansion as confirmed by IVUS. This case report describes a patient who continued clopidogrel treatment for 5 years and was probably protected from a procedural failure. During the current hospitalization, the patient was found to be a responder to clopidogrel after a platelet function assessment with Multiplate (Dynabyte Informationssysteme GmbH, Munich, Germany).

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