[Stent thrombosis: what's up in 2017?]

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Stent thrombosis (ST) remains a serious complication of percutaneous coronary intervention (PCI), despite significant reductions in its incidence.
• Advancements in stent technology and the introduction of novel P2Y12 inhibitors have dramatically decreased ST rates to exceptional levels.
• Optical Coherence Tomography (OCT) has revolutionized the understanding of ST, identifying frequent morphologic abnormalities within the stent.

Purpose of the Study:

• To highlight the current understanding of stent thrombosis (ST) in percutaneous coronary intervention (PCI).
• To emphasize the role of Optical Coherence Tomography (OCT) in diagnosing and understanding ST.
• To discuss optimized strategies for ST prevention.

Main Methods:

• Review of current literature and clinical practice guidelines regarding stent thrombosis (ST) and percutaneous coronary intervention (PCI).
• Emphasis on the diagnostic capabilities of Optical Coherence Tomography (OCT) in identifying endoluminal abnormalities.
• Analysis of therapeutic strategies for ST prevention.

Main Results:

• Stent thrombosis (ST) incidence has become exceptional (0.6% at 1 year, 0.15%/year thereafter) due to improved stents and P2Y12 inhibitors.
• Optical Coherence Tomography (OCT) reveals morphologic endoluminal abnormalities in 97% of ST cases, fundamentally changing its understanding.
• OCT is recognized as an essential tool in clinical practice for guiding therapeutic decisions.

Conclusions:

• Stent thrombosis (ST) prevention relies on correcting mechanical issues and personalizing anti-platelet therapy.
• Optical Coherence Tomography (OCT) is crucial for optimizing treatment strategies and understanding the mechanisms of ST.
• Continued advancements in imaging and pharmacotherapy are key to managing ST risks post-PCI.