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Updated: Jul 5, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Drug-eluting stent thrombosis
1Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA. daniel.h.steinberg@medstar.net
Insights
Drug-eluting stents (DES) reduce restenosis but not death or heart attack. Concerns about late stent thrombosis (LST) and very late stent thrombosis (VLST) after stopping antiplatelet therapy warrant careful review.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials
Background:
- Drug-eluting stents (DES) significantly reduce restenosis and target lesion revascularization compared to bare metal stents (BMS).
- Despite restenosis benefits, DES do not decrease rates of death or myocardial infarction.
- Long-term safety concerns include a potential increase in late stent thrombosis (LST) and very late stent thrombosis (VLST), especially after antiplatelet therapy cessation.
Purpose of the Study:
- To critically appraise drug-eluting stents (DES) and their role in percutaneous coronary intervention.
- To focus on the definitions, incidence, mechanisms, and clinical implications of DES thrombosis.
- To address concerns regarding late and very late stent thrombosis associated with DES.
Main Methods:
- Review of existing literature on drug-eluting stent thrombosis.
- Analysis of factors contributing to DES thrombosis, including patient, lesion, stent, and physician-related elements.
- Examination of the debated incidence and definitions of DES thrombosis.
Main Results:
- DES are effective in reducing restenosis but offer no survival benefit over BMS.
- A small but significant risk of LST and VLST exists with DES, particularly after antiplatelet therapy discontinuation.
- The multifactorial nature of DES thrombosis involves modifiable and non-modifiable factors.
Conclusions:
- The benefits of DES are primarily limited to reducing restenosis.
- Concerns about LST and VLST necessitate a critical evaluation of DES use in percutaneous coronary intervention.
- Understanding the mechanisms and contributing factors is crucial for managing DES thrombosis.
Abstract:
When compared to bare metal stents (BMS), drug-eluting stents (DES) are associated with a dramatic reduction in restenosis and target lesion revascularization. However, the benefit of DES is limited to restenosis, and DES utilization does not translate into reductions in death or myocardial infarction. Additionally, concern exists regarding the long-term safety of DES, as there appears to be a small but real increase in late (LST) and very late stent thrombosis (VLST), seen particularly after the discontinuation of antiplatelet therapy. The specter of LST and VLST has curtailed enthusiasm for widespread DES utilization mandating critical appraisal of DES and the optimal role they play in percutaneous coronary intervention. The incidence of DES thrombosis is debated and varies somewhat by definition. The mechanisms are multifactorial, and involve patient, lesion, stent and physician related factors. Some of these factors are modifiable at the physician-patient level, while others are not. This review focuses on DES thrombosis, with particular attention paid to the definitions, incidence, mechanisms and clinical implications.
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