A representative case of very late stent thrombosis with fragments of atherosclerotic plaques retrieved from lesions with peri-stent contrast staining and incomplete stent apposition.

<p><b>A</b>, <b>B</b> pre and post coronary angiography for 3 sirolimus-eluting stents implantation in the right coronary artery. <b>C</b>, very late stent thrombosis occurred at 1317 days after the index procedure. Peri-stent contrast staining (<b>arrows</b>) was found in the proximal and distal bifurcation lesions in the right coronary artery. Radiolucency (<b>arrow head</b>) suggesting the presence of thrombus was found in the distal bifurcation lesion. <b>D</b>, Intravascular ultrasound demonstrated intra-stent thrombus and incomplete stent apposition with positive arterial remodeling (asterisk). <b>E</b>, cholesterol crystals with foamy macrophages were observed in the aspirated thrombus (hematoxylin and eosin stain). <b>F</b>, eosinophils (arrow) were sparsely observed in the aspirated thrombus (1.9% out of total white blood cells) (Luna stain).