Stents and antiplatelet therapy

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Coronary stents are integral to percutaneous coronary interventions, offering improved mortality in acute coronary syndromes and symptom control in stable angina.
• Despite benefits, stent thrombosis (ST), a critical complication, can occur.
• ST presents challenges, particularly late and very late ST, which are more frequent with drug-eluting stents (DES).

Purpose of the Study:

• To review the incidence, timing, and contributing factors of stent thrombosis (ST).
• To discuss the role of stent design and antiplatelet therapy in ST.
• To highlight future directions for reducing ST.

Main Methods:

• Literature review of studies on coronary stent implantation and stent thrombosis.
• Analysis of factors contributing to early, late, and very late stent thrombosis.
• Evaluation of the impact of stent types (bare metal vs. drug-eluting) and antiplatelet regimens on ST.

Main Results:

• Early ST is linked to procedural factors and occurs similarly with bare metal stents and DES.
• Late and very late ST are more common with DES, associated with incomplete apposition, endothelialization issues, and inflammation.
• Discontinuation or resistance to antiplatelet therapy significantly increases ST risk.

Conclusions:

• Stent thrombosis remains a significant complication of coronary stenting.
• Addressing procedural factors, optimizing stent design, and ensuring effective antiplatelet therapy are crucial for minimizing ST.
• Future innovations in stent technology and antiplatelet strategies hold promise for reducing ST incidence.