Drug-eluting stents (DES) have significantly reduced the incidence of in-stent restenosis (ISR) compared to bare metal stents (BMS). However, recent randomized trials comparing DES with BMS reported few cases of late DES thrombosis. We report the case of late sirolimus-eluting stent thrombosis occurring 22 months after its elective implantation in a restenotic BMS and soon after the interruption of combined anti-platelet therapy with aspirin and Clopidogrel.