Drug-eluting stent thrombosis: current and future perspectives

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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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 (2021). https://doi.org/10.1007/s12928-021-00754-x

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Keywords

  • Stent thrombosis
  • Drug-eluting stent
  • Percutaneous coronary intervention