Simultaneous Stent Obstruction of Triple Vessels with Very Late Stent Thrombosis after Implantation of Sirolimus-Eluting Stents

A 70-year-old man presented to the emergency department at our hospital with chest pain, 24 months after sirolimus-eluting stents (SESs) were implanted in the proximal left anterior descending coronary artery (LAD), middle right coronary artery (RCA), and middle left circumflex artery (LCX), respectively. Electrocardiogram showed complete right bundle branch block and ST-segment elevation in leads II, III, and aVF. He suddenly went to ventricular tachycardia, followed by ventricular fibrillation. Administration of electrical shock led to cardiac arrest. Immediately, we inserted a percutaneous cardiopulmonary system and intra-aortic balloon pumping. Subsequent emergent coronary angiography showed 100% thrombotic total stent obstruction of triple vessels with thrombolysis in myocardial infarction 0 flow. Thrombectomy and balloon angioplasty were performed at the in-stent thrombotic sites. Despite our intensive care, he died due to heart failure on the third day after hospitalization.