Late coronary thrombosis secondary to a sirolimus-eluting stent.

A report by Virmani et al1 described a localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent in a 58-year-old man who died 18 months after stent implantation. The authors discussed a localized hypersensitivity vasculitis in response to the Cypher stents, resulting in an acute myocardial infarction, secondary to late in-stent thrombosis at 18 months. The hypersensitivity reaction was thought to be either due to the metallic stent, the polymer, or the sirolimus coating. The exact mechanism, however, remained unclear, and it was postulated that polymers, like those used for coating of the metallic stent, may have been responsible for the hypersensitivity vasculitis. In October 2003, the US Food and Drug administration notified physicians of …