Stent failure due to simultaneous aggressive neoatherosclerosis of first- and current-generation drug-eluting stents

A 77-year-old man was admitted to our institution with a lateral ST-segment elevation myocardial infarction. Two years earlier, a paclitaxel-eluting stent (PES) and an everolimus-eluting stent (EES) had been implanted separately in the left circumflex coronary artery. Clopidogrel was discontinued after 12 months; aspirin was maintained indefinitely. Coronary angiography proved definite stent thrombosis (ST). After manual thrombus aspiration restenosis involving both stents was observed (Figure 1A). Optical coherence tomography (OCT) detected in-stent heterogeneous, low-intensity and attenuated neointima (Figure 1B, Figure 1C, Figure 1F, Figure 1G, Moving image 1, Moving image 2) compared with the homogeneous, high-intensity signal of adjacent fibrous tissue (Figure 1D, ...