Routine computed tomography (CT) scanning, 1 year after endovascular treatment of a saccular, descending thoracic aortic aneurysm with an Excluder stent-graft (internally covered with polytetrafluoroethylene (PTFE)) (Fig. 1) , revealed intraluminal thrombus formation along its length and circumference (Fig. 2A,B) , despite antiplatelet therapy (acetylsalicylic acid). No hereditary coagulation disorder is known in this patient. Although previously described in abdominal bifurcated stent-grafts, it is an unreported finding in the thoracic aorta.
Intraoperative digital subtraction angiogram of a saccular, mid-descending thoracic aortic aneurysm which has been successfully excluded using a 200-mm-long Excluder stent-graft (diameter 40 mm). At the site of the aneurysm, the stent-graft bulges slightly without kinking.
Contrast-enhanced CT scan of the descending thoracic aorta demonstrating complete exclusion of the aneurysm (diameter 60 mm) by the stent-graft. Surprisingly, however, a large eccentric mural thrombus was observed in the Excluder stent-graft, consisting of a self-expanding Nitinol stent internally covered with a PTFE graft (A). The thrombus continued distally along its full circumference (B).
