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New page: {{SI}} {{CMG}} {{EH}} Stent thrombosis (ST) is a rare but devastating complication of coronary artery stenting that is associated with a high rate of morbidity and mortality <ref>Cutlip...
 
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Stent thrombosis (ST) is a rare but devastating complication of coronary artery stenting that is associated with a high rate of morbidity and mortality <ref>Cutlip DE, Baim DS, Ho KK, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001;103:1967-71.</ref> <ref>Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol 1997;29:6-12.</ref> <ref>Karrillon GJ, Morice MC, Benveniste E, et al. 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 1996;94:1519-27.</ref>
<ref>Orford JL, Lennon R, Melby S, et al. Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry. J Am Coll Cardiol 2002;40:1567-72. </ref>


Over the years stent thrombosis of bare metal stents (BMS) has been minimised by refining stent design, adopting optimal stenting strategies and improved antiplatelet medication usage from a massive 24% in some studies to <ref>Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF, Meier B, Goy JJ, Vogt P, Kappenberger L. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991;324:13–17.</ref> a rare and acceptable 0.5-1.5% in the current environment.
'''Overview:'''


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 ST.  
*[[Stent thrombosis]] (ST) is a rare but devastating complication of coronary artery stenting that is associated with a high rate of morbidity and mortality <ref name="pmid11306525">{{cite journal| author=Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ et al.| title=Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. | journal=Circulation | year= 2001 | volume= 103 | issue= 15 | pages= 1967-71 | pmid=11306525 | doi= | pmc= | url= }} </ref> <ref name="pmid8996288">{{cite journal| author=Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A| title=Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. | journal=J Am Coll Cardiol | year= 1997 | volume= 29 | issue= 1 | pages= 6-12 | pmid=8996288 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8996288  }} </ref> <ref name="pmid8840839">{{cite journal| author=Karrillon GJ, Morice MC, Benveniste E, Bunouf P, Aubry P, Cattan S et al.| title=Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry. | journal=Circulation | year= 1996 | volume= 94 | issue= 7 | pages= 1519-27 | pmid=8840839 | doi= | pmc= | url= }} </ref> <ref name="pmid12427407">{{cite journal| author=Orford JL, Lennon R, Melby S, Fasseas P, Bell MR, Rihal CS et al.| title=Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry. | journal=J Am Coll Cardiol | year= 2002 | volume= 40 | issue= 9 | pages= 1567-72 | pmid=12427407 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12427407  }} </ref>


Increased usage of DES and continued presentation of paients 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.
*This process should not be confused with '''re-stenosis''', a fibro-proliferative disorder which is associated with [[recurrent angina]] and [[ischemia]] but uncommonly with [[myocardial infarction]] or death.


Recent description of frequent subclinical insitu thrombus formation within DES in the coronaries by Katani et al<ref>Kotani, J, Awata, M, Nanto, S, et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J Am Coll Cardiol 2006; 47:2108.</ref>, not only took the medical community by surprise but afforded a first hand in-vivo glimpse at the stent site itself. It should be noted that the term coronary stent thrombosis (ST) is commonly used for clinically significant episodes. <ref>Sotirios Tsimikas, Drug-Eluting Stents and Late Adverse Clinical Outcomes; Lessons Learned, Lessons Awaited; editorial comment; JACC Vol. 47, No. 10, 2006</ref>


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.
'''Stent thrombosis with [[bare metal stent]] vs [[drug eluting stent]]:'''


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.
*Over the years stent thrombosis of [[bare metal stents]] ([[BMS]]) has been minimised by refining stent design, adopting optimal stenting strategies and improved [[antiplatelet]] medication usage from a massive 24% in some studies to <ref name="pmid1984159">{{cite journal| author=Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF et al.| title=Angiographic follow-up after placement of a self-expanding coronary-artery stent. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 1 | pages= 13-7 | pmid=1984159 | doi=10.1056/NEJM199101033240103 | pmc= | url= }} </ref> 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 [[ST]].
**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<ref name="pmid16697331">{{cite journal| author=Kotani J, Awata M, Nanto S, Uematsu M, Oshima F, Minamiguchi H et al.| title=Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 10 | pages= 2108-11 | pmid=16697331 | doi=10.1016/j.jacc.2005.11.092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16697331  }} </ref>, 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. <ref name="pmid16697332">{{cite journal| author=Tsimikas S| title=Drug-eluting stents and late adverse clinical outcomes lessons learned, lessons awaited. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 10 | pages= 2112-5 | pmid=16697332 | doi=10.1016/j.jacc.2006.03.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16697332  }} </ref>
 
*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.




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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.


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]


Stent thrombosis with bare metal stent vs drug eluting stent:

  • Over the years stent thrombosis of bare metal stents (BMS) has been minimised by refining stent design, adopting optimal stenting strategies and improved antiplatelet medication usage from a massive 24% in some studies to [5] 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 ST.
    • 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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.

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