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(Circulation. 2007;116:1952-1965.)
© 2007 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Late Coronary Stent Thrombosis

Stephan Windecker, MD; Bernhard Meier, MD

From the Department of Cardiology, University Hospital Bern, Bern, Switzerland.

Correspondence to Bernhard Meier, MD, Professor and Chairman of Cardiology, Cardiovascular Department, University Hospital Bern, 3010 Bern, Switzerland. E-mail bernhard.meier@insel.ch

Key Words: devices, medical • angioplasty • balloon • infarction • stents • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Introduced >20 years ago,¹ coronary artery stents have improved the safety and particularly the efficacy of percutaneous coronary interventions (PCIs).² Abrupt vessel closure, complicating 6% to 8% of balloon angioplasty procedures, was associated with a 5% mortality, 40% rate of myocardial infarction (MI), and 40% rate of emergency coronary artery bypass grafting.³ Stents significantly reduced these adverse events (Figure 1).^4,5 The reduction of restenosis afforded by bare metal stents (BMS) was modest (30% to 40%). Repeat revascularization still occurred in 15% to 20% of cases.⁶ Drug-eluting stents (DES) with antiproliferative drugs attached via polymers on the stent surface to minimize smooth muscle proliferation have reduced restenosis and rates of target lesion revascularization by 50% to 70% compared with BMS across nearly all lesion and patient subsets.⁷ Initially⁸ and again more recently,^9–16 safety concerns were raised about DES, particularly about late stent thrombosis (ST).

View larger version (7K):   Figure 1. Outcome of 112 patients with abrupt vessel closure in the prestent balloon angioplasty experience of a registry (1985 to 1986; total, 1801 patients)3 and 339 patients with abrupt vessel closure during balloon angioplasty treated with BMS (Palmaz-Schatz) (total, 4596 patients).5 CABG indicates coronary artery bypass grafting.

	Historical Perspective

 
ST was a bane of stent implantation from the beginning. The initial experience with Wallstents in the late 1980s was overshadowed by ST rates approaching 24%.¹⁷ Subsequent series with Palmaz-Schatz and Gianturco-Roubin stents (still predominantly bailout stenting) observed ST in 6% to 12% of cases.^4,18 The postprocedural antithrombotic regimen at the time consisted of aspirin, often in . . . [Full Text of this Article]

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