Stent thrombosis introduction
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Smita Kohli, M.D.; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Stent thrombosis (ST) is a rare but devastating complication of coronary artery stenting that is associated with a high rate of morbidity and mortality [1] [2] [3] [4] This process should not be confused with restenosis, a fibro-proliferative disorder which is associated with recurrent angina and ischemia but uncommonly with myocardial infarction or death.
The Risk of Stent Thrombosis Associated with Bare Metal and Drug Eluting Stents
- Over the years stent thrombosis of bare metal stents (BMS) has been minimized by refining stent design, adopting optimal stenting strategies and improved antiplatelet medication usage from early rates of 24% [5] to a rare and acceptable 0.5-1.5% in the current environment.
- Following the approval by the FDA, the drug eluting stents (DES) largely replaced BMS, driven solely by the reduced revascularization with relatively little attention paid to the issue of stent thrombosis.
- Increased usage of DES and continued presentation of patients with ST beyond the first few months of implantation, coupled with the widespread awareness of ST, have led to a steady and increased stream of reporting of ST in DES.
- Recent description of frequent subclinical insitu thrombus formation within DES in the coronaries by Katani et al[6], not only took the medical community by surprise but afforded a first hand in-vivo glimpse at the stent site itself.
Treatment
- It should be noted that the term coronary stent thrombosis (ST) is commonly used for clinically significant episodes. [7]
- In this context, clinically significant ST appears to be a rare complication with devastating consequences if left untreated emergently, though the mileu for such probably exists in a much larger population.
References
- ↑ Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ; et al. (2001). "Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials". Circulation. 103 (15): 1967–71. PMID 11306525.
- ↑ Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A (1997). "Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome". J Am Coll Cardiol. 29 (1): 6–12. PMID 8996288.
- ↑ Karrillon GJ, Morice MC, Benveniste E, Bunouf P, Aubry P, Cattan S; et al. (1996). "Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry". Circulation. 94 (7): 1519–27. PMID 8840839.
- ↑ Orford JL, Lennon R, Melby S, Fasseas P, Bell MR, Rihal CS; et al. (2002). "Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry". J Am Coll Cardiol. 40 (9): 1567–72. PMID 12427407.
- ↑ Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF; et al. (1991). "Angiographic follow-up after placement of a self-expanding coronary-artery stent". N Engl J Med. 324 (1): 13–7. doi:10.1056/NEJM199101033240103. PMID 1984159.
- ↑ Kotani J, Awata M, Nanto S, Uematsu M, Oshima F, Minamiguchi H; et al. (2006). "Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings". J Am Coll Cardiol. 47 (10): 2108–11. doi:10.1016/j.jacc.2005.11.092. PMID 16697331.
- ↑ Tsimikas S (2006). "Drug-eluting stents and late adverse clinical outcomes lessons learned, lessons awaited". J Am Coll Cardiol. 47 (10): 2112–5. doi:10.1016/j.jacc.2006.03.019. PMID 16697332.