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Subacute stent thrombosis: evolving issues and current concepts

K H Mak1, G Belli, S G Ellis

  • 1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.

Journal of the American College of Cardiology
|February 1, 1996
PubMed
Summary
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Intracoronary stents improve angioplasty results but carry a risk of thrombosis. Contemporary techniques and careful patient selection significantly reduce stent thrombosis rates, enhancing procedural safety.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Intracoronary stents are vital for percutaneous coronary revascularization, improving outcomes over balloon angioplasty.
  • However, subacute stent thrombosis remains a significant complication, increasing morbidity and mortality.

Purpose of the Study:

  • To review factors contributing to stent thrombosis.
  • To assess the impact of evolving procedural techniques on stent thrombosis incidence.

Main Methods:

  • Systematic review of English MEDLINE articles (1988-1995) using keywords "stent" and "thrombosis."
  • Inclusion of stent registry data and scientific meeting abstracts.
  • Categorization of studies based on stent placement (emergent vs. elective), conduit type, and use of high-pressure balloon inflations and anticoagulation.

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Main Results:

  • Sixty studies involving 7,914 patients were reviewed.
  • Subacute thrombosis was higher in emergent (10.1%) versus elective (4.3%) stent placements.
  • Contemporary trials using high-pressure balloon inflations showed a lower thrombosis rate (1.3%), even with reduced anticoagulation.

Conclusions:

  • Stent thrombosis risk is influenced by clinical setting, lesion characteristics, stent type, and procedural technique.
  • Proper case selection and modern procedural techniques can significantly mitigate the risk of stent thrombosis.