Late stent thrombosis after drug-eluting stent implantation: a rare case of accelerated neo-atherosclerosis and early manifestation of neointimal rupture

Diagnosis and Evaluation of Stent Thrombosis with Optical Coherence Tomography

Stent thrombosis (ST) is a rare complication of percutaneous coronary interventions (PCI), especially with drug-eluting stents. ST presents as acute myocardial infarction requiring emergent repeat PCI; optimal reperfusion occurs in two-thirds of patients. As a result, ST has been associated with a high mortality rate and a high rate of recurrent thrombosis. We discuss the use of optical coherence tomography (OCT) for the diagnosis and evaluation of ST. OCT-guided ST management seems a feasible, safe, and appropriate approach. Intracoronary assesses the efficacy of coronary thrombus removal procedures and detects the prevalent stent-related factor that caused ST.

Risk factors for coronary drug-eluting stent thrombosis: influence of procedural, patient, lesion, and stent related factors and dual antiplatelet therapy

The complication of stent thrombosis (ST) emerged at a rate of 0.5% annually for first-generation drug-eluting stents (DES), often presenting as death or myocardial infarction. Procedural factors such as stent underexpansion and malapposition are risk factors for ST in patients. The type of lesion being treated and lesion morphology also influence healing after treatment with DES and can contribute to ST. Second-generation DES such as the XIENCE V everolimus-eluting stent differ from the first-generation stents with respect to antiproliferative agents, coating technologies, and stent frame. Improvements in stent structure have resulted in a more complete endothelialization, thereby decreasing the incidence of ST. Bioresorbable scaffolds show promise for restoring vasomotor function and minimizing rates of very late ST. Post-PCI treatment with aspirin and clopidogrel for a year is currently the standard of care for DES, but high-risk patients may benefit from more potent antiplatelet agents. The optimal duration of DAPT for DES is currently unclear and will be addressed in large-scale randomized clinical trials.