Prevention of stent thrombosis: challenges and solutions

Abstract

Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. This review analyzes the entity of stent thrombosis from a historical and clinical perspective, and chronicles the evolution of this condition through the various generations of stent development, from bare metal to first-generation, second-generation, and third-generation drug-eluting stents. It also delineates the specific risk factors associated with stent thrombosis and comprehensively examines the literature related to each of these risks. Finally, it highlights the preventative strategies that can be garnered from the existing data, and concludes that a multifactorial approach is necessary to combat the occurrence of stent thrombosis, with higher risk groups, such as patients with ST segment elevation myocardial infarction, meriting further research.

Keywords: post-procedural myocardial infarction; preventative strategies; stent thrombosis.

Figure 1

Incomplete stent strut coverage. Notes: (A) A well-expanded stent with adequate stent strut coverage by endothelialization. (B) Poor neointimal coverage of similar stent struts, creating a risk factor for stent thrombosis. Red indicates arterial wall; blue indicates neointimal coverage; gray indicates stent strut.

Figure 2

Strategies to prevent stent thrombosis. Abbreviations: IVUS, intravenous ultrasound; OCT, optical coherence tomography; ST, stent thrombosis.