Predictors of Coronary Stent Thrombosis

Werkum, Jochem W. van; Heestermans, Antonius A.C.M.; Zomer, Anoek; Kelder, Johannes C.; Suttorp, Maarten-Jan; Rensing, Benno J.; Koolen, Jacques; Brueren, B R G; Dambrink, Jan‐Henk E.; Hautvast, Raymond W.M.; Verheugt, Freek W.A.; Berg, Jürrien M. ten

doi:10.1016/j.jacc.2008.12.055

Cited by 627 publications

(142 citation statements)

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“…When a stenting strategy is applied, selection of the appropriate stent diameter may be of particular importance during PPCI, since stent undersizing is one of the most powerful predictor of ST among non-elective PCI [92] . Actually, the reference vessel diameter of the IRA may be difficult to accurately assess during PPCI, because of thrombus burden, cathecholamine stimulation and inflammatory substances, that can contribute to general and localized vasocostriction [93] .…”

Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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“…Additionally, it is of paramount importance to achieve the largest possible lumen cross-sectional area. Many studies (with both metal stents and scaffolds) identify a small final lumen cross-sectional area as a predictor of ST. 67 The Virchow triad for thrombogenesis can be almost completely controlled by the operator. 65 The doctor can optimize: (1) the lumen with appropriate pre-and postdilation; and (2) the flow by selecting the appropriate vessel (with adequate size, run-off, without myocardial bridging and supplying viable myocardium).…”

Section: Current Status Between Promises and Pitfalls Of Bvsmentioning

confidence: 99%

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Testa

Latib

Montone

et al. 2016

Circ: Cardiovascular Interventions

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Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).

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“…Currently, the prevalence of AST varies between 0.1 and 1.7% [1,2,3,15]. Cumulative incidence of AST was 0.6% (140 out of 21,009 patients) [19] and 0.1% (24 out of 23,500 patients) [20] based on 2 large-scale and multicenter registry studies. European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial indicated that the risk period for AST was limited to the first few hours (median time to AST was 2.3 h, interquartile range 1.9-2.8 h) after PCI [1].…”

Section: Epidemiologymentioning

confidence: 99%

Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis

Li³

2017

Cardiology

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Acute stent thrombosis (AST) is a rare but life-threatening complication of coronary artery stenting. AST remains a challenging task for cardiologists, despite the application of modern procedural techniques and dual-antiplatelet therapy strategies as well as improved understanding of the underlying pathophysiology. This review focuses on the prevalence, risk factors, prognosis, multiple potential underlying pathogenesis, knowledge gaps, and recommends diagnosis and individualized management strategies of AST.

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Predictors of Coronary Stent Thrombosis

Abstract: Important correlates of ST were identified. Discontinuation of clopidogrel, undersizing of the coronary stent, present malignancy, and intermediate (>or=50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST.

Cited by 627 publications

References 20 publications

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis

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