Related Experiment Videos
Stent thrombosis: historical perspectives and current trends
1Cardiology Unit, The University of Rochester Medical Center, Rochester, New York 14642, USA. donald_cutlip@urmc.rochester.edu
Insights
Coronary stent thrombosis rates have decreased due to modern deployment and anti-platelet strategies. Optimal therapy involves emergent revascularization and anti-thrombotic treatment for stent thrombosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Coronary stents are utilized in over 70% of percutaneous coronary revascularization procedures.
- Initial concerns regarding stent thrombosis and bleeding complications have evolved with treatment advancements.
Observation:
- High-pressure stent deployment and anti-platelet regimens have reduced stent thrombosis to ~1%.
- Stent thrombosis now occurs earlier, with a median of 1 day post-procedure.
- Risk factors include multiple stents, residual dissection, and smaller final lumen size.
Findings:
- Modern strategies significantly lower stent thrombosis incidence without increasing bleeding risk.
- Earlier stent thrombosis timing necessitates prompt recognition and intervention.
- Platelet glycoprotein IIb/IIIa inhibitors may further mitigate thrombosis in high-risk cases.
Implications:
- Continued optimization of stent deployment and anti-thrombotic therapy is crucial.
- Understanding evolving risk factors aids in preventing stent thrombosis.
- Prompt treatment of stent thrombosis, though challenging, remains critical for patient outcomes.
Abstract:
Coronary stents are now implanted in more than 70% of percutaneous coronary revascularization procedures. Early enthusiasm for improved acute angiographic results and limited restenosis was dampened initially by a high rate of stent thrombosis and later by the increased bleeding complications of aggressive and complex anticoagulation protocols designed to lower the stent thrombosis risk. More recently, routine high-pressure deployment strategies and anti-platelet drug regimens have lowered the incidence of stent thrombosis to approximately 1% without an increased bleeding risk. The timing of stent thrombosis has also changed from a median of 4-5 days to a median of 1 day after the stent procedure. Risk factors in earlier studies included stenting for threatened or abrupt closure, smaller vessels, longer lesions, and possibly left anterior descending artery lesion location. Modern studies have shown a slightly increased risk for multiple stent use, residual dissection, and smaller final lumen. Optimal therapy for stent thrombosis includes emergent revascularization and anti-thrombotic treatment, although the clinical consequences remain dire despite successful reperfusion. The use of platelet glycoprotein IIb/IIIa inhibitors, especially in high-risk situations may further reduce the incidence of stent thrombosis.