Stent thrombosis introduction

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

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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

• 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.

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 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, 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.

• 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.