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Drug-eluting stent thrombosis in 2011: still an issue?

  • Pathological predictors - S Bailey (San Antonio, US) - Slides 
  • Genetic predictors - J-P Collet (Paris, FR) - Slides 
  • Clinical and angiographic predictors - T A Bass (Jacksonville, US) - Slides 
  • Evidence from clinical trials - S Windecker (Bern, CH) - Slides 

Following concerns initially raised at the 2006 ESC meeting in Barcelona that suggested an increased incidence of stent thrombosis, much additional evaluation of patients receiving drug eluting stents (DES) has occurred. Insights into the clinical, technical and pharmacologic aspects of the issue lead to identification of at risk populations, for example diabetic patients. Intravascular ultrasound and OCT studies gave further insight into appropriate stent sizing and incomplete stent apposition which contribute to stent thrombosis in general but in particular to DES. Long term studies confirmed that DES do not re-endothelialise at the same rate as bare metal stents placing patients at risk for very late events.

Along with a better understanding of the clinical and technical aspects of patients at risk for thrombosis additional, more potent antiplatelet agents have also been developed which have been shown to be more effective in reducing thrombosis. In addition, new insights into the pharmacology of the drugs have occurred, particularly an understanding of genetic differences in the metabolism of these medications. This has been in parallel with improvements in stent design and the development of different antiproliferative drugs. While stent thrombosis remains a concern all of this has led to DES thrombosis rates that are in general less than 1%, which represents a very significant improvement in the occurrence of this sometimes catastrophic event.




Drug-eluting stent thrombosis in 2011: still an issue?

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.