Outcomes of stent thrombosis and restenosis during extended followup of patients treated with baremetal coronary stents citations doyle b, rihal cs, osullivan cj, lennon rj. Stent thrombosis following baremetal stent implantation. The actual incidence of st reported in the literature depends on the duration of followup utilized. Manual thrombectomy followed by direct stenting was the recommended. Although many randomized trials and studies support the overall early and longterm safety and efficacy of the firstgeneration drugeluting stents des, 1,2 concern has been raised on longterm safety, especially regarding the potential risk of late stent thrombosis st. Pdf only stent fracture and thrombosis visualized by a combination of enhanced stent visualization and optical coherence tomography oba, yusuke. Stent thrombosis is a rare condition that occurs when a blood clot forms on the surface of a stent, raising the risk of blood flow in an artery being reduced or cut off. If the blood clot makes its way into an artery in the lung, it is called a. May 06, 2020 stent thrombosis is a dangerous condition that occurs when a blood clot forms on a stent. Many studies usually involve few stent thrombosis patients, generally less than 60, given its prevalence. Xience sierra everolimus eluting coronary stent system 3. Stent thrombosis rates in scaar registry boston scientific.
Stent thrombosis within the first year appears to occur with similar frequency in patients with bare metal stents bms or drugeluting stents des, as long as patients are treated with. Intense investigation continues on the pathobiology of stent thrombosis st because of its morbidity and mortality. Arterial thrombosis is generally more serious because the supply of oxygen and nutrition. Thus, mortality due to stent thrombosis has been reported to be as high as 45 % 3. As the advantages of stent implantation saw its evolution from a.
Introduction stent thrombosis is a rare but devastating complication of pci. Longstenting, even with a secondgeneration drugeluting stent des, is an independent predictor of restenosis and stent thrombosis in patients with long coronary lesions. Oct 24, 2014 coronary stent thrombosis nightmare for cardiologist 2. Coronary stent thrombosis nightmare for cardiologist 2. Many studies usually involve few stent thrombosis patients, generally less than. During the early bms era, st was demonstrated to be as high as 20.
Stent thrombosis can be categorized according to the timing of occurrence into early 30 days. Posted in cardiology interventional pci, cardiology therapeutics, cardiology journal club, cardiologyland mark studies, tagged academic research consortium, classification of stent thrombosis, sub acute stent thrombosis on july 27, 2011 leave a comment. This is usually an acute process in contrast to restenosis, which is a gradual narrowing of the stent lumen due to neointimal proliferation. Des have remarkably reduced the incidence of stentrestenosis srs and. Desbms for early and late st frequently in firstgeneration des risk factorsmodifiablemost address patient lesion stent dapt prevention is better a good. Perioperative stent thrombosis open access journals. Coronary angiogram demonstrated acute stent thrombosis during primary percutaneous coronary intervention. Stent thrombosis is a rare complication of percutaneous coronary intervention and carries a poor prognosis. Acute stent thrombosis following concomitant balloon. A representative case showing late stent thrombosis with uncovered. Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. Evolving concepts and perspectives ronen jaffe, bradley h.
Pdf technology of drugeluting stent des implantation is relatively young. Posted in cardiology interventional pci, cardiology therapeutics, cardiology journal club, cardiologyland mark studies, tagged academic research consortium, classification of stent thrombosis, sub. While stent thrombosis is very rare, it is a serious condition. Coronary stent thrombosis has been defined by the academic research consortium criteria. A case series of stent thrombosis during the covid19 pandemic. For several years restenosis was the achilles heel of coronary artery stenting by limiting longterm efficacy. Lower risk of stent thrombosis and restenosis with. It has symptoms much like cardiac thrombosis of any kind and it is classed by the time in which. Jan 27, 2015 stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. A case series of stent thrombosis during the covid19. Basel stent costeffectiveness triallate thrombotic events trial overview acc 2006 mortality data from the basket late trial and premier registry basketprove.
Stent thrombosis can occur acutely within 24 hours, subacutely within 30 days, or as late as one year late or more very late after stent placement. Using the dapt score to predict stent thrombosis vs. Objectives the aim of this study was to examine the incidence, correlates, and consequences of intraprocedural stent thrombosis ipst in patients with acute coronary syndromes acs. Mattia galli, felicita andreotti, domenico damario, italo porto and filippo crea. Stent fracture and thrombosis visualized by a combination. A, b, and c emergent angioplasty for first time stent thrombosis. So far, exclusively in the reality trial, which compared both des platforms directly, a significant increase in the rate of stent thrombosis was reported for patients who actually received a taxus stent 1. Stent thrombosis often results in an acute coronary syndrome, while restenosis often results in anginal symptoms. It has symptoms much like cardiac thrombosis of any kind and it is classed by the time in which it occurs after the placement of the stent. Patients with coronary stents need to be on dual antiplatelet therapy in order to minimize the risk of stent thrombosis.
Coronary evaginations are associated with the use of sirolimuseluting. A new standard definition of stent thrombosis was recently proposed by an academic research consortium arc in order to make it possible to compare the true rates of stent thrombosis across different trials and registries 4. Bleeding mar 29, 2016 debabrata mukherjee, md, facc a 76yearold male with past history of smoking and a prior myocardial infarction mi two years ago for which he was treated medically presents for evaluation. Coronary stent infection presented as recurrent stent.
Coronary evaginations are associated with the use of sirolimuseluting stents, local hypersensitivity, flow disturbance, uncovered strut, stent malapposition, thrombosis, and target lesion revascularization. Stent thrombosis with dual antithrombotic therapy in atrial fibrillationacspci trials. Late and very late thrombosis of drugeluting stents. With deep vein thrombosis dvt, blood clots form in the large veins deep within the legs, pelvis and sometimes in the arms. Because little advance has been made in outcomes following st, ongoing research. Adverse events, like late stent thrombosis, are very rare. While stent thrombosis is very rare, it is a serious condition that can cause a future heart attack or even death.
Stent thrombosis definition of stent thrombosis by the. After either a bare metal or drugeluting stent is implanted, there is a small risk of stent thrombosis. Frequency of and risk factors for stent thrombosis after drugeluting stent implantation during longterm followup. Stent thrombosis article about stent thrombosis by the. The concurrence of a systemic allergic reaction and in stent thrombosis is defined as type 3 kounis syndrome. The enroute transcarotid stent system used in conjunction with the enroute transcarotid neuroprotection system nps is indicated for the treatment of patients at high risk for adverse events from carotid endarterectomy, who require carotid revascularization and meet the criteria outlined below patients with neurological symptoms and 50% stenosis of the common or. Stent thrombosis with dual antithrombotic therapy in. Stent thrombosis is an infrequent but catastrophic complication of percutaneous coronary intervention pci. Acute closure of the metallic endo prosthesis, the so called stent thrombosis st, is associated with high rates of morbidity and mor tality. So far, exclusively in the reality trial, which compared both des platforms directly, a significant increase in the rate of stent thrombosis was reported for patients who actually received a taxus.
Stent thrombosis st is the sudden occlusion of a stented coronary artery due to thrombus formation. Bare metal stent thrombosis occurs in in stent technology and new antiplatelet therapies have reduced the incidence of stent thrombosis. During the early bms era, st was demonstrated to be as high as. Therefore, acute stent thrombosis can be successfully treated with thrombus aspiration, potent platelet aggregation inhibitor and balloon angioplasty. This article requires a subscription or purchase to view the full text. The stent lengthlesion was an independent predictor of st hazard ratio. Clinical guidelines for the use of drug eluting coronary. Treating deep vein thrombosis with angioplasty and stenting. Recent improvements in stent technology and new antiplatelet therapies. Dvt strikes about 1 in 20 people over the course of a lifetime. Late stent thrombosis is also associated with des due to impaired arterial healing with a lack if reendothelialization and fibrin deposition due to underlying chronic inflammation more commonly. Following this, advances in the field of interventional cardiology, including high pressure post dilatation and importantly, the addition of ticlopidine to aspirin, led to a significant. Coronary angiogram demonstrated acute stent thrombosis.
Patients presenting with an acute coronary syndrome. A representative case showing late stent thrombosis with uncovered struts following drugeluting stent implantation. The synergy bp stent demonstrated the numerically lowest stent thrombosis rates compared to. The most feared complication related to coronary stent placement is stent thrombosis, which, although fortunately rare occurring in. Instent neoatherosclerotic thin cap fibroatheroma tcfa has been described, and rupture of instent tcfa are a potential source of very late stent thrombosis. The patient became asymptomatic for chest pain after revascularization. Results stent thrombosis occurred in 68 patients 2. Mar 29, 2016 using the dapt score to predict stent thrombosis vs. Sirolimus and paclitaxel on polymerbased drugeluting. To resolve this issue and standardize the diagnosis, academic research consortiumarc came up with the definitions of stent thrombosis which will be discussed in this section. While dual antiplatelet therapy has decreased stent thrombosis significantly in the general population, there are still patients who present with occurrence and.
The relationship and threshold of stent length with regard. Stent thrombosis in patients with drug eluting stents and. At 1 year follow up, clopidogrel was interrupted without any changing of the of the remaining therapy. Predictors and clinical implications of stent thrombosis in patients. Stent thrombosis is a dangerous condition that occurs when a blood clot forms on a stent. Herein, we describe the first case of acute stent thrombosis due to the combined coronary and valve intervention cvi. Although many randomized trials and studies support the overall early and longterm safety and efficacy of the firstgeneration drugeluting stents des, 1,2 concern has.
Angioplasty and stents have been extremely successful in opening clogged arteries and improving the lives of patients. The clinical consequences of st are frequently catastrophic and include death in 2048% or. Realworld studies demonstrate low event rates for the synergy bioabsorbable polymer bp stent. Because little advance has been made in outcomes following st, ongoing research is focused on further understanding predictive factors as well as st frequency and timing in various patient subsets, depending upon whether a drugeluting stent or baremetal stent has been implanted. Stent thrombosis, with haziness at proximal a and distal edge d as well as at the bifurcation c 1e. After a stent is inserted, there is a very small chance that a blood clot could form on the surface of the stent. May 21, 2020 this is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of. Strauss stent thrombosis after percutaneous coronary intervention. According to the academic research consortium arc, the definition includes definite, probable, or possible st and is described in detail elsewhere 1. Reasons for premature discontinuation of antiplatelet therapy include surgery, intolerance, complications and poor compliance. The synergy bp stent demonstrated the numerically lowest stent thrombosis rates compared to other des, despite being used in patients with more complex disease. A case of very late stent thrombosis after sirolimus. Risk of st is directly related to the acuity of the index clinical syndrome preceding stenting.
This file is licensed under the creative commons attributionshare alike 3. If you are a subscriber or member, click the login link or the subscribe. This is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the. With the subsequent increase in use of stents during percutaneous coronary intervention pci, the focus of treatment evolved from procedural. Histologic section from a 47yearold male who had overlapped drugeluting stents paclitaxeleluting stent. Strauss stent thrombosis after percutaneous coronary intervention is an uncommon and potentially catastrophic event that might manifest as myocardial infarction and sudden death. Definition based on timing of stent thrombosis st acute stent thrombosis. Stent thrombosis st is an uncommon but lifethreatening complication after percutaneous coronary intervention pci, frequently manifesting as acute coronary syndrome acs or even cardiac death. Stent thrombosis is a thrombotic occlusion of a coronary stent.
Bleeding mar 29, 2016 debabrata mukherjee, md, facc a 76yearold male with past history of smoking and a prior. After one year, the rate of stent thrombosis was 0. Clopidogrel 75 mgdie, asa 100 mgdie, carvedilol 6,25 mg x 2, tresiba 20 ui x 1, novorapid x 3, atorvastatin 20 mgdie. Calcific neoatherosclerosis is particularly problematic for treatment because the calcific tissue is constrained by the stent, which makes. You may do so in any reasonable manner, but not in. Stent thrombosis should be differentiated from instent stenosis, which is the process whereby gradual hyperplasia of the smooth muscle cells within the implanted stent can lead to the recurrence of stenosis or in some cases complete occlusion of the stent over time.