Stent thrombosis: Introduction

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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

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 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 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.

Recent description of frequent subclinical insitu thrombus formation within DES in the coronaries by Katani et al, 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.

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.

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.