Coronary Stent Thrombosis — Predictors and Prevention

Ullrich, Helen; Münzel, Thomas; Gori, Tommaso

doi:10.3238/arztebl.2020.0320

Cited by 44 publications

(78 citation statements)

References 54 publications

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“…In this modern stent-based PCI era, ST represents a fatal and life-threatening complication. According to previous reports, the risk of ST is strongly associated with both, the patient background and procedural aspects [ 1 , 3 ]. Certain patient background factors are independent predictors of a bleeding risk; malignant disease is a strong risk factor for major bleeding after PCI, as well as ST [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to previous reports, the risk of ST is strongly associated with both, the patient background and procedural aspects [ 1 , 3 ]. Certain patient background factors are independent predictors of a bleeding risk; malignant disease is a strong risk factor for major bleeding after PCI, as well as ST [ 1 ]. Our patient was classified as having a high thrombotic (4 points: anemia, heart failure, diabetes mellitus) and bleeding (4 points: heart failure, prior myocardial infarction, malignancy) risk, according to the CREDO-Kyoto thrombotic and bleeding risk scores [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Incomplete neointimal coverage of the struts in the early phase is normal, but the risk of ST associated with this procedure needs to be minimized. This risk could be reduced by optimizing stent placement with intracoronary imaging techniques and developing newer DES technology [ 1 ]. Moreover, dual-antiplatelet therapy (DAPT) with aspirin and a P2Y 12 receptor blocker after coronary stent implantation has been effective in preventing ST, and has been the standard treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Stent thrombosis (ST) is a rare but serious complication of PCI. Malignant disease is known as a strong risk factor for the development of ST and hemorrhage after stent implantation [ 1 ]. In addition, many modern chemotherapies are associated with vascular complications such as thrombosis and major bleeding [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Early stent thrombosis confirmed in a cancer patient receiving regorafenib, despite triple antithrombotic therapy: a case report

Kudoh

Zen

Ookura

et al. 2021

BMC Cardiovasc Disord

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Background While developments in oncology have lengthened survival in patients with cancer, such patients often develop cardiovascular diseases. Thus, percutaneous coronary intervention (PCI) is frequently undertaken in them. Although stent thrombosis remains a fatal complication in stent-based PCI, worldwide consensus panels tend to recommend shorter duration of dual-antiplatelet therapy. This is based on its clinical efficacy that has resulted from technological innovation. However, there is insufficient discussion on the risk of stent thrombosis in cancer patients with coronary artery disease, especially in those undergoing chemotherapeutic regimens that have a risk for thrombosis, such as regimens with the anti-vascular endothelial growth factor. Presented here is a case of early stent thrombosis that occurred in a cancer patient on regorafenib, despite the administration of triple antithrombotic therapy. Case presentation A 66-year-old Japanese male patient received regorafenib for metastatic colorectal carcinoma and apixaban for deep vein thrombosis. Coronary angiography revealed severe stenosis in the proximal left anterior descending artery. A sirolimus-eluting stent was implanted, without malapposition and under-expansion, under intravascular ultrasound guidance while administering a triple antithrombotic therapy (aspirin: 100 mg/day, prasugrel: 3.75 mg/day, and apixaban: 5 mg/day). However, he was admitted to the hospital for exacerbation of heart failure 1 month after PCI. Coronary angiography revealed contrastive defects in the previous stent. Optical frequency domain imaging confirmed stent thrombosis. PCI was successfully performed with perfusion balloon long-inflation. Antithrombotic therapy was enhanced (aspirin: 100 mg/day, ticagrelor: 120 mg/day, and apixaban: 10 mg/day) and regorafenib was discontinued permanently. While ischemic events did not occur thereafter, the patient died due to metastatic carcinoma progression. Conclusions This case suggests that anti-vascular endothelial growth factor might contribute to early stent thrombosis, despite triple antithrombotic therapy. Further discussion is needed on the surveillance and management of cancer patients with coronary artery disease receiving chemotherapy, which carries a risk of thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early stent thrombosis confirmed in a cancer patient receiving regorafenib, despite triple antithrombotic therapy: a case report

Kudoh

Zen

Ookura

et al. 2021

BMC Cardiovasc Disord

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“…Thus, while the multifactorial nature of stent failure is acknowledged [ 13 ], the present review will focus on the biological responses that follow stent implantation, and how these may lead to stent failure across the different generations of stents.…”

Section: Introductionmentioning

confidence: 99%

Vascular Wall Reactions to Coronary Stents—Clinical Implications for Stent Failure

Gori

2021

Life

Self Cite

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Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5–20%. It is therefore important to understand these reactions and how different they are among different generations of stents.

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Corroded iron stent increases fibrin deposition and promotes endothelialization after stenting

Deng

Wen

Yin

et al. 2022

Bioengineering & Transla Med

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Poststent restenosis is caused by insufficient endothelialization and is one of the most serious clinical complications of stenting. We observed a rapid endothelialization rate and increased fibrin deposition on the surfaces of the corroded iron stents. Thus, we hypothesized that corroded iron stents would promote endothelialization by increasing fibrin deposition on rough surfaces. To verify this hypothesis, we conducted an arteriovenous shunt experiment to analyze fibrin deposition in the corroded iron stents. We implanted a corroded iron stent in both the carotid and iliac artery bifurcations to elucidate the effects of fibrin deposition on endothelialization. Co‐culture experiments were conducted under dynamic flow conditions to explore the relationship between fibrin deposition and rapid endothelialization. Our findings indicate that, from the generation of corrosion pits, the surface of the corroded iron stent was rough, and numerous fibrils were deposited in the corroded iron stent. Fibrin deposition in corroded iron stents facilitates endothelial cell adhesion and proliferation, which, in turn, promotes endothelialization after stenting. Our study is the first to elucidate the role of iron stent corrosion in endothelialization, pointing to a new direction for preventing clinical complications caused by insufficient endothelialization.

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Coronary Stent Thrombosis — Predictors and Prevention

Cited by 44 publications

References 54 publications

Early stent thrombosis confirmed in a cancer patient receiving regorafenib, despite triple antithrombotic therapy: a case report

Early stent thrombosis confirmed in a cancer patient receiving regorafenib, despite triple antithrombotic therapy: a case report

Vascular Wall Reactions to Coronary Stents—Clinical Implications for Stent Failure

Corroded iron stent increases fibrin deposition and promotes endothelialization after stenting

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