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Fibrinolytic therapy for very late stent thrombosis--is it a viable option?

Abdul Hakeem1, Sabha Bhatti, Imran Arif

  • 1Division of Cardiovascular Diseases, College of Medicine, University of Cincinnati, Cincinnati, OH 45257-0542, USA. ahakeem@gmail.com

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|October 12, 2010
PubMed

Insights

Very late stent thrombosis (ST) carries high mortality. Fibrinolytic therapy may be a viable option for ST-related ST-elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) is unavailable.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Stent thrombosis (ST) is a serious complication following coronary stent placement, associated with high mortality and morbidity.
  • Drug-eluting stents (DES) show an increased risk of very late ST compared to bare-metal stents up to 4 years post-implantation.
  • Discontinuation of antiplatelet therapy, specifically clopidogrel, is a primary risk factor for ST.

Observation:

  • ST-elevation myocardial infarction (STEMI) secondary to ST presents with worse outcomes and lower reperfusion rates than de novo STEMI.
  • Prompt revascularization is critical for STEMI due to ST, given its significantly higher associated mortality.
  • This case highlights the potential role of fibrinolytic therapy in managing STEMI caused by very late ST.

Findings:

  • Very late stent thrombosis (ST) is associated with significant risks, particularly with drug-eluting stents (DES).
  • Discontinuation of clopidogrel is the most critical risk factor for stent thrombosis.
  • Fibrinolytic therapy demonstrated potential utility in a case of STEMI due to very late ST.

Implications:

  • Systemic fibrinolysis should be considered for ST-related STEMI in cases of ongoing ischemia where prompt percutaneous coronary intervention (PCI) is not feasible.
  • This approach may improve outcomes in specific high-risk scenarios of stent thrombosis.
  • Further research into the role of fibrinolysis for very late ST is warranted.

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