Stent Failure Management in Contemporary Clinical Practice.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Contemporary stent technology has advanced, yet stent failure (SF), including in-stent restenosis (ISR) and stent thrombosis (ST), remains a clinical challenge.
• SF affects a notable percentage of patients post-percutaneous coronary intervention (PCI).

Purpose of the Study:

• To compare clinical characteristics, presentation, angiographic findings, and management of patients with SF versus de novo lesions undergoing PCI.
• To identify the underlying mechanisms and procedural strategies for SF management.

Main Methods:

• Observational, single-center study comparing 101 SF cases with patients undergoing PCI for de novo lesions.
• Analysis of baseline characteristics, clinical presentation, procedural interventions, and intravascular imaging findings.

Main Results:

• SF occurred in 9% of 1120 PCI patients; 75% had ISR, 25% had ST.
• SF patients had higher rates of diabetes, dyslipidemia, and prior bypass surgery, and lower rates of current smoking.
• Drug-coated balloons (44%) and plain balloon angioplasty (8.9%) were used more frequently in SF cases compared to de novo lesions (5.3% and 0.7%, respectively).
• Intracoronary imaging use was higher in the SF group (33% vs. 13%).
• Stent malapposition and neoatherosclerosis were key mechanisms for ST and ISR, respectively.
• Procedural success rates were comparable (96% vs. 98%).

Conclusions:

• About 1 in 10 PCI patients experience stent failure.
• Intracoronary imaging plays a crucial role in managing SF.
• While drug-eluting stent implantation is standard for de novo lesions, drug-coated balloons are a preferred alternative for ISR.
• Interventional cardiologists must master intravascular imaging interpretation for optimal SF treatment outcomes.