Related Experiment Video
Updated: Jun 8, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Coronary stent thrombosis in the current era: challenges and opportunities for treatment
Bastiaan Zwart1, Jochem W van Werkum, Antonius A C M Heestermans
1Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Insights
Stent thrombosis (ST) remains a significant risk after stent implantation, influenced by various factors. Understanding these determinants aids in risk stratification and personalized prevention strategies for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Drug-eluting stents (DES) have raised concerns about stent thrombosis (ST), especially late and very late ST.
- ST is a serious complication associated with significant morbidity and mortality following both bare metal and drug-eluting stent implantation.
Purpose of the Study:
- To highlight the persistent concern of stent thrombosis (ST) following stent implantation.
- To emphasize the evolving understanding of ST pathophysiology and its implications for clinical practice.
Main Methods:
- Review of identified clinical, procedural, and angiographic risk factors for ST.
- Inclusion of novel determinants like on-treatment reactivity, genetic predisposition, and stent-vessel wall interactions.
- Synthesis of current knowledge into a multifactorial model of ST pathophysiology.
Main Results:
- ST remains a critical concern, necessitating awareness among cardiologists.
- Pathophysiology of ST is now understood as complex and multifactorial, incorporating traditional and novel risk factors.
- Enhanced understanding facilitates risk stratification and guides treatment options.
Conclusions:
- Optimal prevention of ST involves addressing modifiable risk factors and individualized patient treatment.
- Future advancements in genetic testing, platelet function assays, and imaging may further refine ST management.
- A comprehensive approach to ST prevention and management is crucial for improving patient outcomes.
Opinion Statement:
The introduction of the drug-eluting stent has raised concerns regarding the occurrence of stent thrombosis (ST), particularly late (and very late) thrombosis. This renewed attention shows that ST remains a major concern after implantation of both bare metal and drug-eluting stents. Cardiologists should be aware of this dreadful complication, because it is associated with substantial morbidity and mortality. Numerous clinical, procedural, and angiographic risk factors have been identified. Moreover, the influence of novel determinants, such as high on-treatment reactivity, genetic predisposition, and the stent's direct effects on the (healing of the) vessel wall, now are recognized. Consequently, the pathophysiology of ST has evolved into a complex multifactorial model. This broader understanding of the pathophysiology of ST enables cardiologists to perform extensive risk stratification to identify patients at higher risk and provides clues to important treatment options. The core of primary prevention after stent implantation, as well as secondary prevention after ST, should consist of a) the prevention of modifiable risk factors and b) optimal individualized treatment for each patient. Future developments, such as genetic bedside testing, point-of-care platelet testing, and sophisticated imaging modalities, might aid in this approach.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:26Atherosclerosis III: Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Angina IV: Management