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Published on: January 18, 2018

Stent thrombosis: an updated clinical overview from epidemiology to classification and management

Lucio Giuseppe Granata1, Marcello Marchetta2, Giulia Alagna3

  • 1Cardiology Division, National Centre of Excellence Garibaldi Hospital, Garibaldi-Nesima Hospital, Catania, Sicily, Italy dr.granatacardiologo@gmail.com.

Heart (British Cardiac Society)
|May 8, 2026
PubMed

Insights

Stent thrombosis (ST) after coronary stent implantation remains a severe complication despite advances. Understanding its timing-based mechanisms is key to improving diagnosis and management strategies for better patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Coronary stent implantation is a cornerstone of percutaneous coronary intervention (PCI), significantly reducing vessel closure and restenosis.
  • Despite advancements in drug-eluting stents and antiplatelet therapies, stent thrombosis (ST) persists as a critical complication with high mortality.
  • ST presents diverse mechanisms depending on the timing of occurrence: intraprocedural, early, late, and very late phases.

Purpose of the Study:

  • To review current definitions, epidemiology, and underlying mechanisms of stent thrombosis.
  • To outline diagnostic pathways and contemporary therapeutic strategies for acute ST management.
  • To summarize preventive measures, including imaging-guided implantation and optimized dual antiplatelet therapy (DAPT).

Main Methods:

  • This narrative review synthesizes current literature and recent consensus recommendations.
  • It integrates data on diagnostic modalities, particularly intravascular imaging like optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
  • The review examines therapeutic interventions and preventative strategies for ST.

Main Results:

  • Early ST is often linked to procedural issues (e.g., underexpansion, malapposition) or inadequate DAPT.
  • Late and very late ST can result from delayed healing, late-acquired malapposition, neoatherosclerosis, or hypersensitivity reactions (Kounis syndrome type III).
  • Intravascular imaging is crucial for identifying ST mechanisms and guiding treatment; drug-coated balloons offer a metal-free option for select late presentations.

Conclusions:

  • Effective management of ST requires a multi-faceted approach, including rapid reperfusion, mechanical optimization, and potent antithrombotic therapy.
  • Prevention strategies emphasize precise stent implantation guided by intravascular imaging, individualized DAPT regimens, and rigorous control of cardiovascular risk factors.
  • Continued research and adherence to updated guidelines are essential for mitigating the risks associated with coronary stenting.

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