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Review
. 2020 May 1;117(18):320-326.
doi: 10.3238/arztebl.2020.0320.

Coronary Stent Thrombosis- Predictors and Prevention

Helen Ullrich  1 , Thomas Münzel, Tommaso Gori
Affiliations
Review

Coronary Stent Thrombosis- Predictors and Prevention

Helen Ullrich et al. Dtsch Arztebl Int. .

Abstract

Background: Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are complex. Because of the seriousness of this situation, all phy - sicians should have at least basic knowledge of it. In this article, we present the risk factors for ST and discuss some innovative approaches to its treatment.

Methods: This review is based on pertinent articles retrieved by a selective search in PubMed, and on current international guidelines and expert recommendations.

Results: The frequency of ST has been markedly lowered by technical advances in coronary stenting and by the implementation of modern implantation techniques, including the introduction of coverage with dual antiplatelet therapy (DAPT). Both patient-related risk factors and procedural aspects can elevate the risk of ST. The independent risk factors for ST include premature termination of DAPT (hazard ratio [HR] 26.8; 95% confidence interval [8.4; 85.4]; p <0.0001), malignant disease (odds ratio [OR]: 17.45; [4.67; 65.26]; p <0.0001), and diabetes mellitus (OR: 3.14; [1.33; 7.45]; p = 0.0093). In comparison to angiographically guided procedures, the use of intracoronary imaging techniques in patients with acute coronary syndrome lowers the frequency of ST (0.6% versus 1.2%; p = 0.005). These techniques enable the detection of many findings in the coronary arteries that are associated with the development of ST. In such cases, countermeasures such as secondary stent dilatation or prolongation of DAPT can help prevent ST.

Conclusion: As the pathophysiology of ST is multifactorial, research in this area presents a special challenge. Prospective clinical trials will be needed to determine whether the systematic use of imaging techniques can lower the frequency of ST.

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Figures

Figure 1:
Figure 1:
Predictors of stent thrombosis: selected findings in optical coherence tomography a) Normal finding: good result following implantation of a drug-eluting stent (DES), neointimal coverage of stent struts b) Evaginations: outward bulging of the luminal vessel contour between the struts of a DES c) Malapposition: lack of contact between the abluminal stent surface and the vessel wall, including incomplete neointimal coverage of the stent struts d) 3D reconstruction of a stent fracture: the arrows point to the broken, dislocated struts of a DES e) 3D reconstruction of a stent fracture: the arrow points to stenosis within the fractured stent, resulting in reduced blood flow (red)
Figure 2
Figure 2
Mechanism of development as well as targeted preventive and treatment measures for stent thrombosis (ST)
See this image and copyright information in PMC

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