[A case of late drug-eluting stent thrombosis during postoperative period after 5 years of stent implantation].

ABSTRACT

Stent thrombosis during perioperative period is a critical complication for patients treated with drug-eluting stent (DES). We experienced a case of late DES thrombosis 5 years after initial implantation. A 48-year-old man with familial hyperlipidemia, angina pectoris and chronic pulmonary emphysema, was diagnosed with esophageal carcinoma, and scheduled for esophagectomy. He was first treated with DES 5 years ago, and he underwent repeated revascularization for re-stenosis. He had received anti-platelet therapy up to 1 week prior to the current operation, which was replaced by heparin administration. The surgical procedure was uneventful, and he tolerated it well. Immediately after his admission to ICU, sporadic premature ventricular contraction and ST-elevation occurred, leading to ventricular fibrillation. Emergent coronary angiography revealed re-stenosis of the right coronary artery treated with DES 5 years ago. At present, there was no definite guideline, on the management of DES during perioperative period. It is important for us to decide continuing antiplatelet therapy balancing the risk of stent thrombosis with surgical bleeding in each patient.