Coronary artery stents: II. Perioperative considerations and management

Area of Science:

• Cardiology
• Perioperative Medicine
• Interventional Cardiology

Background:

• Perioperative management of patients with coronary artery stents is a critical patient safety concern.
• Stent thrombosis, myocardial infarction, and death are life-threatening risks, especially after non-cardiac surgery early post-implantation.
• Discontinuing dual-antiplatelet therapy preoperatively significantly increases complication rates.

Purpose of the Study:

• To outline strategies for managing patients with coronary artery stents during the perioperative period.
• To provide recommendations for regional anesthesia and postoperative care to mitigate risks.
• To propose algorithms for the management of bare-metal and drug-eluting stents.

Main Methods:

• Review of current literature and clinical guidelines.
• Consideration of risk factors for perioperative stent thrombosis.
• Development of management algorithms based on stent type and procedural risk.

Main Results:

• Aspirin continuation is generally recommended throughout the perioperative period, balancing bleeding risk.
• The postoperative period presents the highest risk for perioperative stent thrombosis.
• Immediate percutaneous coronary intervention is the definitive treatment for stent thrombosis.

Conclusions:

• Perioperative management protocols are essential for patient safety in those with coronary stents.
• Algorithms aid clinicians in making informed decisions regarding antiplatelet therapy and surgical timing.
• Readily available 24-h interventional cardiology services are vital for managing emergent stent thrombosis.