Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Abstract

Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors.

Drug-eluting stents for coronary artery disease in the perspective of bibliometric analysis

“…Optimal update of stent medications: Stent implantation often causes damage to the vascular endothelium. When the process of vascular reendothelialization is not smooth, it can lead to in-stent thrombus formation and restenosis ( 122 , 123 ). The primary objective of optimizing stent medications is to prevent vascular events by safeguarding endothelial cells and mitigating the adverse impacts on vascular smooth muscle cells and inflammatory cells.…”

Future of Endovascular and Surgical Treatments of Atherosclerotic Intracranial Stenosis

“…37 The implementation of DES in cerebral vasculature is more fraught with challenges, not only due to the reduced navigability of the bulkier devices in the more tortuous cerebral vessels, but also due to the risk of late stent thrombosis and consequent stroke. 40 Various types of polymer coating and the antiproliferative properties of the drug may significantly delay the process of endothelialization following stent placement and, in turn, promote late stent thrombosis. To minimize this risk, patients typically require dual antiplatelet therapy (DAPT) for more extended periods following DES relative to bare metal stent, with the attendant incremental risk of bleeding complications.…”

Strategies for surface coatings of implantable cardiac medical devices

“…Moreover, intravascular injuries result in in-stent restenosis. One viable solution to solve this complication is using drug eluting stents (DES) ( Liu et al, 2014 ; Condello et al, 2023 ). DES are a time-ordered drug release; these types of stents are made of stainless steel, nickel-titanium, and cobalt-chromium and coated with biodegradable polymers to achieve loading drugs (see Table 1 ) ( Borhani et al, 2018 ).…”