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Narrowing of the iliac artery is a common presentation of systemic atherosclerosis. With the recent development of invasive techniques, angioplasty and stenting offer excellent results for fixing limb ischemia of aorto-iliac arteries. However, despite novel interventional approaches and constantly increasing experience, complications such as distal embolization, stent migration, acute or subacute iliac artery occlusion, dissection, and perforations are still challenging. Early restenosis and/or reocclusion of peripheral artery stents is uncommon, but the risk of delayed or late thrombotic occlusions of iliac artery stents is unclear. Although with questionable impact, hypercoagulable state or patient noncompliance may contribute to the pathogenesis of stent thrombosis. We describe a patient with terminal renal cell carcinoma who developed late iliac artery stent thrombosis despite dual chronic antiplatelet therapy with aspirin and clopidogrel. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]