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We report here on one patient who suffered from acute myocardial infarction that was due to late stent thrombosis, and this was associated with late stent malapposition very late (21 months) after the deployment of a paclitaxel-eluting stent and shortly after (7 days) the discontinuation of the aspirin therapy. The intravascular ultrasound examination revealed that the late stent thrombosis was accompanied by late stent malapposition. This is a report on late stent thrombosis associated with late stent malapposition after the successful implantation of a paclitaxel-eluting stent (PES).