Stent thrombosis in the DES era

Park, Kyung Woo; Kim, Hyo Soo

Abstract

Although drug eluting stents (DES) have mostly replaced bare metal stents (BMS) for the treatment of coronary artery stenosis, concern has been raised regarding the possibility of increased stent thrombosis after DES implantation. Despite the relative low frequency of ST, it is of intense interest to clinicians because of its high morbidity and mortality. There is much controversy regarding many aspects of ST and only recently has there been a unified definition of ST proposed by the Academic Research Consortium. We are in need of much more knowledge and insight into the risk factors and pathophysiology of ST as well as what can be done to overcome ST. However, investigators do agree on a few points based on various clinical trials, registry reports, and meta-analyses: 1) The frequency of ST does not seem to differ between BMS and DES, although DES seems to be slightly more prone to late ST; 2) The incidence of ST is very low but its consequences are potentially fatal; 3) several risk factors may be involved in the development of ST and more studies are required to more accurately elucidate the clinical, angiographic, procedural, and maybe genetic risk factors of ST; 4) improvements in DES design along with better adjunctive drug treatment are required in the future to improve long term safety.