Recurrent In-Stent Thrombosis Despite Optimal DAPT

Key finding

**Optical coherence tomography (OCT) imaging revealed stent underexpansion** that was invisible on standard angiographic assessment. The conventional angiogram — the imaging modality used in most catheterization labs worldwide — failed to detect that the stent was not fully apposed to the vessel wall. This mechanical failure created a nidus for recurrent thrombosis. The 17-day window of three thrombotic events despite optimal DAPT points to a mechanism beyond platelet resistance — the problem was structural, and it required intravascular imaging to diagnose. ---

Framework connections: The Burn and Crash Model, The Signal Fire (IL-6)

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