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Abstract
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.
Highlights
Cardiovascular disease accounts for roughly one-third of human mortality throughout the world [1]
Despite these concerns about late stent thrombosis with drug-eluting stents (DES), long-term followup of randomized DES versus BMS trials showed that after accounting for ST events after procedures for restenosis, which occur more commonly after BMS than DES, the overall incidence of ST is not increased with DES compared to BMS [40], and the overall late rates of death and myocardial infarction (MI) are similar with DES and BMS [41]
There is emerging evidence that secondgeneration stents, XIENCE V, have significantly lower ST rates compared to first generation stents
Summary
Cardiovascular disease accounts for roughly one-third of human mortality throughout the world [1]. -called “sudden cardiac death” (SCD) accounts for over half of all fatalities from cardiovascular disease, and remains a significant challenge to human health and longevity [2, 3]. This review will focus on a specific clinical and anatomic subset of coronary thrombosis that can lead to MI and SCD of thrombotic occlusion of a previously-stented coronary artery (stent thrombosis, ST) [4,5,6]. While a reliable and permanent solution for ST has remained elusive so far, considerable progress has been made in decreasing its incidence through optimal deployment techniques, improved stent design, and effective antiplatelet therapies
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