Very Late Stent Thrombosis and Late Target Lesion Revascularization: No End in Sight
Randomized trials and registries have clearly demonstrated that drug-eluting stents (DES) are effective in reducing restenosis1,2. Following their introduction and an initial period of unbridled enthusiasm, it was recognized that there was a significant increase in very late stent thrombosis (VLST) when compared to bare metal stents (BMS) and this late complication has been the subject of continued concern and intensive investigation. Very late ST is fortunately infrequent but it is associated with very high rates of death and myocardial infarction. Understanding the frequency, duration and potential mechanisms of VSLT have been hampered by the lack of large studies where low frequency events can be more accurately determined and evaluated. Randomized trials, typically evaluating low risk patients, have shown a low rate of VLST averaging 0.2%/year but rates in registries with off label use are higher, averaging 0.6%/year2,3. Some studies have suggested a plateau after 3 years while others have not4. Due to the selective nature of these trials, the incidence and time course in an unrestricted population is unclear. (SELECT FULL TEXT TO CONTINUE)
- Received December 8, 2011.
- Accepted December 16, 2011.
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