Stent thrombosis : Historical perspectives and current trends

Coronary stents are now implanted in more than 70% of percutaneous coronary revascularization procedures. Early enthusiasm for improved acute angiographic results and limited restenosis was dampened initially by a high rate of stent thrombosis and later by the increased bleeding complications of agg...

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Bibliographic Details
Published in:Journal of thrombosis and thrombolysis 2000-08, Vol.10 (1), p.89-101
Main Author: CUTLIP, Donald E
Format: Article
Language:English
Subjects:
Biological and medical sciences
Diseases of the cardiovascular system
Hemorrhage - chemically induced
Hemorrhage - etiology
History, 20th Century
Humans
Medical sciences
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Risk Factors
Stents - adverse effects
Stents - history
Stents - trends
Thrombosis - drug therapy
Thrombosis - etiology
Thrombosis - prevention & control
Time Factors
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Summary:Coronary stents are now implanted in more than 70% of percutaneous coronary revascularization procedures. Early enthusiasm for improved acute angiographic results and limited restenosis was dampened initially by a high rate of stent thrombosis and later by the increased bleeding complications of aggressive and complex anticoagulation protocols designed to lower the stent thrombosis risk. More recently, routine high-pressure deployment strategies and anti-platelet drug regimens have lowered the incidence of stent thrombosis to approximately 1% without an increased bleeding risk. The timing of stent thrombosis has also changed from a median of 4-5 days to a median of 1 day after the stent procedure. Risk factors in earlier studies included stenting for threatened or abrupt closure, smaller vessels, longer lesions, and possibly left anterior descending artery lesion location. Modern studies have shown a slightly increased risk for multiple stent use, residual dissection, and smaller final lumen. Optimal therapy for stent thrombosis includes emergent revascularization and anti-thrombotic treatment, although the clinical consequences remain dire despite successful reperfusion. The use of platelet glycoprotein IIb/IIIa inhibitors, especially in high-risk situations may further reduce the incidence of stent thrombosis.
ISSN:0929-5305
1573-742X
DOI:10.1023/A:1018763108106