# “Very” Very Late Stent Thrombosis: A Detailed Look at Two Cases

## TL;DR

This paper presents two rare cases of stent thrombosis occurring more than five years after stent implantation and discusses their implications.

## Contribution

The study adds two new clinical cases to the limited literature on 'very' very late stent thrombosis.

## Key findings

- Two cases of 'very' very late stent thrombosis presented as ST-elevation myocardial infarction.
- The paper emphasizes the need for further research to better understand and prevent this rare complication.

## Abstract

Although percutaneous coronary intervention (PCI) has radically transformed the scope of treating coronary artery disease with stenting, stent thrombosis (STh) remains a feared complication. Very late STh, a rare complication after PCI, refers to STh occurring greater than one year after post-stent implantation. An even rarer phenomenon, “very” very late stent thrombosis (VVLST), is described in the literature as STh occurring more than five years post-stent implantation. To our knowledge, there are only 10 case reports and one case series describing VVLST. We discuss two additional complex clinical cases of VVLST presenting as ST-elevation myocardial infarction. We highlight epidemiology, pathophysiology, presentation, diagnostic methods, treatment approach, associated complications, and the need for more extensive future work to minimize the risk of VVLST.