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Drug-eluting stent thrombosis: current and future perspectives

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Abstract

Over the past 40 years, the safety and efficacy of percutaneous coronary intervention has dramatically improved by overcoming several challenges. The introduction of drug-eluting stent (DES) in particular was a major breakthrough in interventional cardiology. Compared to bare-metal stents, first-generation DES (G1-DES) has dramatically reduced the rates of in-stent restenosis and subsequent target lesion revascularization. However, major safety concerns surrounding stent thrombosis (ST) emerged with G1-DES in clinical practice as a result of the high incidences of death, myocardial infarction, and repeat revascularization associated with ST. To overcome these limitations, second-generation DES (G2-DES) has been developed with an improved stent platform with thinner strut and biocompatible durable or biodegradable polymers. Indeed, G2-DES, when compared with G1-DES, has improved clinical outcomes by reducing the risk of late thrombotic events while maintaining anti-restenotic efficacy, whereas ST still occurs, even with the use of G2-DES. This review gives an overview of pathophysiology, risk factors, and outcomes of ST after DES implantation. Additionally, we discuss the management and prevention of ST.

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Authors and Affiliations

  1. Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-8555, Japan

    Shoichi Kuramitsu & Kenji Ando

  2. Second Department of Internal Medicine, University of Occupational and Environmental Health Japan School of Medicine, Kitakyushu, Japan

    Shinjo Sonoda & Reo Anai

  3. Division of Cardiology, Department of Internal Medicine, Kobe University Graduates School of Medicine, Kobe, Japan

    Hiromasa Otake

  4. Department of Cardiovascular Medicine, Saga University, Saga, Japan

    Masahiro Natsuaki

  5. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA

    Yasuhiro Honda

  6. Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan

    Kazushige Kadota

  7. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

    Yoshio Kobayashi

  8. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Takeshi Kimura

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  1. Shoichi Kuramitsu
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Correspondence to Shoichi Kuramitsu.

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Kuramitsu, S., Sonoda, S., Ando, K. et al. Drug-eluting stent thrombosis: current and future perspectives. Cardiovasc Interv and Ther 36, 158–168 (2021). https://doi.org/10.1007/s12928-021-00754-x

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