Contemporary antithrombotic strategies in patients undergoing coronary stent implantation

The number of annual stenting procedures has been increasing at a rapid pace since coronary stents were first used in clinical practice just over a decade ago. Subacute stent thrombosis, which usually has serious clinical consequences, plagued the stent early experience despite intense anticoagulation therapy. The reduction of stent thrombosis was among the factors that contributed to stent growth and widespread acceptance in recent years. This was the result of improved implantation techniques, advances in adjunctive pharmacotherapy and evolution in stent designs, delivery systems and non-thrombogenic coatings. However, novel designs and materials customized for particular lesion types and newer anti-restenotic treatments could influence stent thrombogenicity. Intravascular brachytherapy and drug-eluting stents have been shown to reduce the incidence of in-stent restenosis preventing cellular proliferation. However, by interfering with the re-endothelization process they may also increase the risk of stent thrombosis. To prevent a recrudescence of this feared complication, future research direction must focus on the hemocompatibility aspects of new technologies, along with further refinement of stent-deployment techniques and antithrombotic strategies.