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Stent thrombosis 

Stent thrombosis
Chapter:
Stent thrombosis
Author(s):

Mariuca Vasa-Nicotera

and Tony Gershlick

DOI:
10.1093/med/9780199569083.003.029
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date: 24 February 2020

Over the past three decades, new strategies have rapidly evolved to achieve coronary reperfusion of ischaemic myocardium in patients with coronary artery disease (CAD). Studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) have shown that the long-term rates of death and/or myocardial infarction (MI) are substantially the same, justifying the increasing and widespread use of PCI. PCI is the dominant reperfusion therapy for such patients with the ratio of numbers of PCIs undertaken to CABG performed being 4:1 in the United Kingdom and up to 8:1 in other parts of Europe. A recurrent issue during the evolution of PCI has been the difference between PCI and CABG in the percentage of patients requiring a repeat procedure (reintervention). To date, the need of reintervention has been less with CABG and this is due to the development of in-stent restenosis that occurs after PCI. Restenosis is the re-narrowing of the vessel, which requires a repeat procedure. The rate of restenosis with early balloon angioplasty has been high. The implantation of bare metal stents (BMS) and then drug-eluting stents (DES) has reduced significantly the incidence of restenosis. While such improved overall clinical outcomes with DES has supported the use of these in preference to BMS, another long-term complication has somewhat tempered the enthusiasm for their use: the possibility that implantation of DES would result in an excess of occlusive stent thrombosis (ST).

This chapter will analyse the data on the incidence, causes, and clinical consequences of ST, and will outline the ongoing and future preventive and therapeutic initiatives. Finally, the risk/benefit of DES will be addressed.

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