Stent thrombosis introduction


 * Associate Editors-in-Chief: Smita Kohli, M.D.; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

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 restenosis, a fibro-proliferative disorder which is associated with recurrent angina and ischemia but uncommonly with myocardial infarction or death.

The Risk of Stent Thrombosis Associated with Bare Metal and Drug Eluting Stents

 * Over the years stent thrombosis of bare metal stents (BMS) has been minimized by refining stent design, adopting optimal stenting strategies and improved antiplatelet medication usage from early rates of 24% 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 stent thrombosis.
 * 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.