Semin Thromb Hemost 2018; 44(01): 046-051
DOI: 10.1055/s-0037-1606178
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stent Thrombosis

Mukesh Gopalakrishnan
1   Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
,
Amir S. Lotfi
1   Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2017 (online)

Abstract

The most dreaded complication with percutaneous coronary intervention with stents, either bare-metal or drug-eluting stents is stent thrombosis (ST) and it has a significant detrimental effect on the outcome for the patient. The initial attempts at intervention with bare-metal stents had much higher rates of ST compared with what is currently prevailing in the modern interventional world. Significant changes with respect to the stent technology, pharmacology, and most importantly our understanding of this phenomenon have decreased the risk of ST. There are many factors that can be performed to minimize the risk of ST and this review will describe the incidence, pathophysiology, and contributing risk factors to ST.

 
  • References

  • 1 Burzotta F, Parma A, Pristipino C. , et al. Angiographic and clinical outcome of invasively managed patients with thrombosed coronary bare metal or drug-eluting stents: the OPTIMIST study. Eur Heart J 2008; 29 (24) 3011-3021
  • 2 Cutlip DE, Windecker S, Mehran R. , et al; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115 (17) 2344-2351
  • 3 Doyle B, Rihal CS, O'Sullivan CJ. , et al. Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation 2007; 116 (21) 2391-2398
  • 4 Riegger J, Byrne RA, Joner M. , et al; Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Investigators. Histopathological evaluation of thrombus in patients presenting with stent thrombosis. A multicenter European study: a report of the prevention of late stent thrombosis by an interdisciplinary global European effort consortium. Eur Heart J 2016; 37 (19) 1538-1549
  • 5 Lüscher TF, Steffel J, Eberli FR. , et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 2007; 115 (08) 1051-1058
  • 6 D'Ascenzo F, Bollati M, Clementi F. , et al. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 2013; 167 (02) 575-584
  • 7 Kimura T, Morimoto T, Kozuma K. , et al; RESTART Investigators. Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART). Circulation 2010; 122 (01) 52-61
  • 8 Joner M, Finn AV, Farb A. , et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48 (01) 193-202
  • 9 Cheneau E, Leborgne L, Mintz GS. , et al. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation 2003; 108 (01) 43-47
  • 10 Stone GW, Witzenbichler B, Guagliumi G. , et al; HORIZONS-AMI Trial Investigators. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008; 358 (21) 2218-2230
  • 11 Serruys PW, Chevalier B, Dudek D. , et al. A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomised controlled trial. Lancet 2015; 385 (9962): 43-54
  • 12 Dangas GD, Claessen BE, Mehran R. , et al. Development and validation of a stent thrombosis risk score in patients with acute coronary syndromes. JACC Cardiovasc Interv 2012; 5 (11) 1097-1105
  • 13 Schömig A, Neumann FJ, Kastrati A. , et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334 (17) 1084-1089
  • 14 Steigen TK, Maeng M, Wiseth R. , et al; Nordic PCI Study Group. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 2006; 114 (18) 1955-1961
  • 15 Steg PG, van 't Hof A, Hamm CW. , et al; EUROMAX Investigators. Bivalirudin started during emergency transport for primary PCI. N Engl J Med 2013; 369 (23) 2207-2217
  • 16 Dangas G, Aymong ED, Mehran R. , et al; CADILLAC Investigators. Predictors of and outcomes of early thrombosis following balloon angioplasty versus primary stenting in acute myocardial infarction and usefulness of abciximab (the CADILLAC trial). Am J Cardiol 2004; 94 (08) 983-988
  • 17 Colombo A, Hall P, Nakamura S. , et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91 (06) 1676-1688
  • 18 Stone GW, Witzenbichler B, Weisz G. , et al; ADAPT-DES Investigators. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 2013; 382 (9892): 614-623
  • 19 Wiviott SD, Braunwald E, McCabe CH. , et al; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357 (20) 2001-2015
  • 20 Wallentin L, Becker RC, Budaj A. , et al; PLATO Investigators. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11) 1045-1057
  • 21 Bhatt DL, Stone GW, Mahaffey KW. , et al; CHAMPION PHOENIX Investigators. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med 2013; 368 (14) 1303-1313
  • 22 Valgimigli M, Campo G, Monti M. , et al; Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) Investigators. Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial. Circulation 2012; 125 (16) 2015-2026
  • 23 Kobayashi Y, Teirstein P, Linnemeier T, Stone G, Leon M, Moses J. Rotational atherectomy (stentablation) in a lesion with stent underexpansion due to heavily calcified plaque. Catheter Cardiovasc Interv 2001; 52 (02) 208-211
  • 24 Latib A, Takagi K, Chizzola G. , et al. Excimer Laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry. Cardiovasc Revasc Med 2014; 15 (01) 8-12
  • 25 Cook S, Wenaweser P, Togni M. , et al. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 2007; 115 (18) 2426-2434
  • 26 Biondi-Zoccai GG, Agostoni P, Sangiorgi GM. , et al; Real-world Eluting-stent Comparative Italian retrosPective Evaluation Study Investigators. Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation. Eur Heart J 2006; 27 (05) 540-546
  • 27 Schulz S, Schuster T, Mehilli J. , et al. Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period. Eur Heart J 2009; 30 (22) 2714-2721