Restenosis, Stent Thrombosis, and Bleeding Complications

Abstract

The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure. In the present era of interventional cardiology, the tradeoff between stent thrombosis, restenosis, and bleeding presents as a particularly complex challenge. In this review, the authors highlight major contributors of late/very late stent thrombosis while targeting stent restenosis, and they discuss evolutionary advances in stent technology and antiplatelet therapy, to further improve upon the care of patients with coronary artery disease.

Mechanical and chemical characterisation of bioresorbable polymeric stent over two-year in vitro degradation

“…Recently, several independent clinical trials have raised the thrombosis issue associated with the long-term outcome (three years and beyond) of bioresorbable polymeric stents [31][32][33][34]. The exact cause of the problem has not been identified yet, but stent design and material are believed to play important roles in the long-term performance of bioresorbable polymeric stents.…”

CXCR4-binding PET tracers link monocyte recruitment and endothelial injury in murine atherosclerosis

“…Given that impairment of reendothelialization is the important factor inducing restenosis after percutaneous coronary intervention (48,49), PET imaging of endothelial CXCR4 targeting tracer may also be useful to predict fatal complications after coronary intervention. Even though nowadays restenosis after stenting is drastically reduced by drug-eluting stent, very late stent thrombosis is arising as a too-often fatal problem instead, and this problem is also caused by delayed re-endothelialization (49)(50)(51). Furthermore, this tracer might be useful to detect unstable plaque by recognizing endothelial denudation which is one of the features of plaque vulnerability (52,53) although further human study is necessary because of lack of an animal model of plaque rupture.…”

Riwaroksaban — następny krok w leczeniu choroby niedokrwiennej serca

“…Tym niewątpliwym korzyściom klinicznym towarzyszył niewielki wzrost powikłań krwotocznych (major and minor bleeding) wynoszący 1,9% w porównaniu z 3,1% (p < 0,001), przy czym poważne powikłania krwotoczne, takie jak: krwawienia zakończone zgonem, krwawienia wewnątrzczaszkowe, krwawienia do ważnych narządów wewnętrznych, nie różniły się istotnie od analogicznych odsetków obserwowanych u chorych leczonych jedynie ASA. Badanie to, ze względu na wy-miażdżycowej, jak i procesie jej gojenia [4][5][6]. W seryjnych badaniach tętnic wieńcowych (ultrasonografia wewnątrznaczyniowa [IVUS, intravascular ultrasound], optyczna tomografia koherentna [OCT, optical coherent tomography], angioskopia) dokładnie prześledzono ewolucję zakrzepów przyściennych lub zamykających światło naczynia, tworzących się na pękniętych albo erodujących blaszkach miażdżycowych.…”