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Review
. 2021 Oct 12:16:e27.
doi: 10.15420/icr.2021.03. eCollection 2021 Apr.

Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention

Kalaivani Mahadevan  1 , Claudia Cosgrove  2 , Julian W Strange  1
Affiliations
Review

Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention

Kalaivani Mahadevan et al. Interv Cardiol. .

Abstract

Stent failure remains one of the greatest challenges for interventional cardiologists. Despite the evolution to superior second- and third-generation drug-eluting stent designs, increasing use of intracoronary imaging and the adoption of more potent antiplatelet regimens, registries continue to demonstrate a prevalence of stent failure or target lesion revascularisation of 15-20%. Predisposition to stent failure is consistent across both chronic total occlusion (CTO) and non-CTO populations and includes patient-, lesion- and procedure-related factors. However, histological and pathophysiological properties specific to CTOs, alongside complex strategies to treat these lesions, may potentially render percutaneous coronary interventions in this cohort more vulnerable to failure. Prevention requires recognition and mitigation of the precipitants of stent failure, optimisation of interventional techniques, including image-guided precision percutaneous coronary intervention, and aggressive modification of a patient's cardiovascular risk factors. Management of stent failure in the CTO population is technically challenging and itself begets recurrence. We aim to provide a comprehensive review of factors influencing stent failure in the CTO population and strategies to attenuate these.

Keywords: Stent failure; chronic total occlusion; in-stent restenosis; stent thrombosis; stenting strategy.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Classification of Factors Affecting Stent Failure in Percutaneous Coronary Intervention for Chronic Total Occlusion
Figure 2:
Figure 2:. Considerations and Longer-term Effects for Stent Sizing
Figure 3:
Figure 3:. Accelerated Development of Proximal Native Vessel Disease Post-Coronary Artery Bypass Grafting on CT Coronary Angiography
Figure 4:
Figure 4:. Challenge of Luminal Wiring With In-stent Chronic Total Occlusion
See this image and copyright information in PMC

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