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Updated: May 29, 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 patients undergoing multidigit replantation
Jordan Jacobs1, Alan Shah, Andrew Zinn
1Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA. jacobj15@nyumc.org
Insights
Drug-eluting stents (DES) reduce restenosis but pose thrombosis risks, especially during emergency surgery. Two patients with DES experienced acute thrombosis post-replantation despite dual antiplatelet therapy, highlighting critical management challenges.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Surgical Management
Background:
- Drug-eluting stents (DES) have improved outcomes by reducing in-stent restenosis.
- However, late stent thrombosis (LST) remains a concern, particularly with dual antiplatelet therapy (DAPT) interruption.
- Current guidelines address elective surgery timing but not emergency operations in stented patients.
Observation:
- A retrospective review identified two patients with DES undergoing emergency multidigit replantation.
- Both patients developed acute in-stent thrombosis within days of surgery (postoperative days 2 and 5).
- Thrombosis occurred despite the continuation of dual antiplatelet therapy.
Findings:
- Acute in-stent thrombosis occurred in patients with DES undergoing major emergency surgery.
- Factors such as large transfusion volumes and clopidogrel pharmacogenetics may contribute to thrombosis.
- These cases highlight the challenges of managing patients with DES requiring urgent surgical intervention.
Implications:
- The increasing prevalence of DES necessitates careful consideration for emergency surgical procedures.
- Managing DAPT in patients with DES undergoing major surgery requires further investigation.
- These findings underscore the potential risks of DES thrombosis in complex trauma or surgical scenarios.
Objective:
The development of drug-eluting stents has decreased the rate of in-stent restenosis. However, there have been reports of late stent thrombosis in patients with drug-eluting stents, especially when dual antiplatelet therapy is interrupted. The high mortality rate associated with cardiac stent thrombosis has led to recent recommendations regarding duration of antiplatelet therapy as well as timing of elective surgery in patients with both drug-eluting stents and bare metal stents. However, in patients requiring emergency operations, delaying surgery is not an option.
Data Sources:
In a retrospective review of 65 patients undergoing replantation from 2005 to 2010, only two patients with coronary stents presented, both with drug-eluting stents. Both of these patients developed acute in-stent thrombosis postoperatively (days 5 and 2) despite continuing dual antiplatelet therapy while undergoing multidigit replantation.
Conclusions:
Several factors including large transfusion requirements and the complex pharmacogenetics of clopidogrel may have played a role. These cases bring to light the increasing number of patients with indwelling drug-eluting stents in whom the need for massive surgical or trauma type management will become more frequent.
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