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New insights in stent thrombosis

ESC Congress 2010

New insights in stent thrombosis

Chairpersons: C Macaya (Madrid, ES) – T-H Koh (Singapore, SG)

Incidence and mechanisms (1961). S James (Uppsala,SE)
Stent deployment technique (1962). J Escaned (Madrid, ES)
Platelet function monitoring (1963). FJ Neumann (Bad Krozingen,DE)
Genetics and stent thrombosis (1964). FL Ribichini (Verona, IT)
Invasive and Interventional Cardiology, Cardiovascular Surgery


With the DES era, Stent Thrombosis (ST) has become the major concern of PCI and has left restenosis on a secondary level. Incidence of early ST is about 1% during the first month regardless of stent type (BMS or DES) and 0.5% per year for DES thereafter (STROFA, SCAAR and Bern-Rotterdam Long-term FU Registries). Non-avoidable causes such as clinical (ACS) and anatomical (small vessels, long lesions and bifurcations) scenarios together with inappropriate stent implantation (underexpansion and malapposition) are stronger predictors of an early ST.

Improving stent deployment using imaging techniques (IVUS, OCT and StentBoost) is encouraged in order to reduce the risk of ST (through avoidable causes). On the other hand, cessation of, or low response to clopidogrel increases the risk of ST, and there is some evidence that platelet function measured by bedside tests is associated with outcome after stent implantation.

However, ongoing large clinical studies (GRAVITAS and TRIGGER-PCI) are assessing the benefit of tailored antiplatelet therapy in elective PCI. Increased platelet inhibition using a stronger thienopyridine therapy (prasugrel) significantly reduced both early and late ST in the Triton trial. More recently, the results of the randomized COGENT study provided strong reassurance that there is no clinically relevant adverse drug interaction between clopidogrel and omeprazole (PPIs). Genetic tests could play a role in evaluating drug response and ST risk score, but so far, a direct genetic “cause-effect” has not been established and needs further study. Routine genotyping as a “point of care” for tailored antiplatelet therapy still belongs to the future of personalized medicine.

References


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New insights in stent thrombosis
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.