It is well accepted that drug-eluting stents (DES) are effective in reducing restenosis, although implantation of DES may result in increased occurrence of stent thrombosis. The study describes the case of a patient with very late stent thrombosis (VLST) despite intravascular ultrasound (IVUS) control after implantation of a paclitaxel-eluting stent, an adequate response to antiplatelet therapy, and the lack of distinct risk factors for VLST. Stent thrombosis remains a serious complication after stent implantation even after prolonged time, and studies are urgently needed to optimize diagnosis and treatment of VLST.