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Coronary Stent Thrombosis

  • Geraud Souteyrand
  • Nicolas Combaret
  • Nicolas Amabile
  • Pascal Motreff
Chapter

Abstract

Stent thrombosis is a rare complication of percutaneous coronary intervention and carries a poor prognosis. Recent improvements in stent technology and new antiplatelet therapies have reduced the incidence of stent thrombosis.

Coronary stent thrombosis has been defined by the Academic Research Consortium criteria. Four types of thrombosis are defined according to the time of occurrence from stent implantation: acute (<24 h), subacute (<30 days), late (between 1 month and 1 year), and very late (>1 year). Management consists primarily of urgent restoration of antegrade coronary flow. The concurrent management of platelet aggregation is of paramount importance; compliance with the regimen should be confirmed and a possible resistance to the selected antiplatelet agent should be excluded.

Coronary angiography is limited to determination of the causes of thrombosis. Intracoronary imaging, particularly optical coherence tomography (OCT), can identify the underlying pathology in most cases, allowing selection of the most appropriate management. By employing OCT, a number of pathologies such as malapposition, rupture of neoatherosclerosis, uncovered struts, restenosis, evagination, underexpansion, and dissection of the borders have been identified as risk factors for coronary stent thrombosis, allowing causal and specific treatments. Recommended duration of antiplatelet therapy is regulated by current European Society of Cardiology and American Heart Association/American College of Cardiology guidelines.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Geraud Souteyrand
    • 1
  • Nicolas Combaret
    • 1
  • Nicolas Amabile
    • 2
  • Pascal Motreff
    • 1
  1. 1.Department of CardiologyCHU Clermont-FerrandClermont-FerrandFrance
  2. 2.Department of CardiologyInstitut Mutualiste MontsourisParisFrance

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