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Coronary Stent Thrombosis in the Current Era: Challenges and Opportunities for Treatment

  • Coronary Artery Disease
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

The introduction of the drug-eluting stent has raised concerns regarding the occurrence of stent thrombosis (ST), particularly late (and very late) thrombosis. This renewed attention shows that ST remains a major concern after implantation of both bare metal and drug-eluting stents. Cardiologists should be aware of this dreadful complication, because it is associated with substantial morbidity and mortality. Numerous clinical, procedural, and angiographic risk factors have been identified. Moreover, the influence of novel determinants, such as high on-treatment reactivity, genetic predisposition, and the stent’s direct effects on the (healing of the) vessel wall, now are recognized. Consequently, the pathophysiology of ST has evolved into a complex multifactorial model. This broader understanding of the pathophysiology of ST enables cardiologists to perform extensive risk stratification to identify patients at higher risk and provides clues to important treatment options. The core of primary prevention after stent implantation, as well as secondary prevention after ST, should consist of a) the prevention of modifiable risk factors and b) optimal individualized treatment for each patient. Future developments, such as genetic bedside testing, point-of-care platelet testing, and sophisticated imaging modalities, might aid in this approach.

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Disclosure

Dr. ten Berg has received speaker’s fees from Eli Lilly, Sanofi-Aventis, Merck Sharp & Dohme, and The Medicines Company. Dr. van Werkum has received speaker’s fees from Accumetrics and Siemens and has served on an advisory board for The Medicines Company. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    Bastiaan Zwart MSc, Jochem W. van Werkum MD, PhD & Jurriën M. ten Berg MD, PhD

  2. Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Antonius A. C. M. Heestermans MD

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  1. Bastiaan Zwart MSc
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  2. Jochem W. van Werkum MD, PhD
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  3. Antonius A. C. M. Heestermans MD
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  4. Jurriën M. ten Berg MD, PhD
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Correspondence to Jurriën M. ten Berg MD, PhD.

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Zwart, B., van Werkum, J.W., Heestermans, A.A.C.M. et al. Coronary Stent Thrombosis in the Current Era: Challenges and Opportunities for Treatment. Curr Treat Options Cardio Med 12, 46–57 (2010). https://doi.org/10.1007/s11936-009-0055-z

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