Stent thrombosis, although a rare event, has been the object of considerable interest because of its attendant morbidity and mortality and has come into focus with the advent of drug-eluting stents. We report a case of very late drug-eluting stent thrombosis occurring immediately after an exercise stress echocardiogram, in a patient who, 2 years earlier, had undergone primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). Similar cases reported in the literature and the possible mechanisms of stent thrombosis associated with exercise testing are reviewed.