Stent Thrombosis: A Narrative Review From Pathophysiology to Therapy

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Stent thrombosis (ST) is a rare but critical complication following percutaneous coronary intervention (PCI).
• Despite technological advancements, ST presents significant challenges due to its complex pathophysiology and management.
• High rates of myocardial infarction and mortality are associated with ST.

Purpose of the Study:

• To review the current literature on stent thrombosis.
• To explore pathophysiological mechanisms, clinical predictors, and management strategies for ST.
• To highlight emerging therapeutic and preventive approaches for ST.

Main Methods:

• Conducted a narrative literature review.
• Focused on stent-related, pharmacological, and patient-related factors.
• Examined contemporary management, emerging therapies, and preventive strategies for ST.

Main Results:

• ST results from mechanical issues (malapposition, neoatherosclerosis), pharmacological factors (inadequate dual antiplatelet therapy), and patient conditions (hypercoagulability, inflammation).
• Prompt PCI and intravascular imaging are key for acute ST management.
• Newer stents and imaging-guided PCI reduce ST, with promising adjunctive therapies under investigation.

Conclusions:

• ST necessitates an integrated approach combining optimized PCI, tailored antithrombotic therapy, and risk stratification.
• Advances in device technology, pharmacology, and understanding inflammation are expected to improve ST prevention and outcomes.