Stent Thrombosis With Drug-Eluting Stents

Abstract

First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

“…Recent reports have suggested a paradigm shift in the occurrence of ST after DES implantation as evidenced by lower ST rates in patients with newer generation DES compared with those of BMS. 20, 21 In line with this, the rate of definite/probable ST was significantly higher with BMS vs. DES in the AFCAS registry, although overall 12-month ST rates were relatively low (1.5%). Approximately 9% of patients received a first-generation stent device.…”

Safety and Efficacy of Resolute Zotarolimus-Eluting Stents Compared With Everolimus-Eluting Stents

“…23 Although this early difference in the risk of definite ST diminished during long-term follow-up, 24 there remains uncertainty whether R-ZES and EES feature a different propensity for ST during the periprocedural period. 7,25 Although many randomized trials directly comparing R-ZES and EES were conducted, all of these studies had an inadequate sample size to assess the individual components of the primary composite end points. We therefore undertook this meta-analysis to investigate the clinical performance of R-ZES compared with EES, with a particular focus on device safety (ST) and efficacy (TVR).…”

Vessel Restoration Therapy during Percutaneous Coronary Intervention with Bioresorbable Scaffold

“…"Real-world" BRS outcomes showed scaffold thrombosis in 1.5% of patients at 30 days and 2.1% at six months were noted that exceed the incidences typically reported in contemporary all-comers registries and trials of second-generation drug eluting stents (DES) [5]. Our single center BRS registry data showed 0.5% scaffold thrombosis in two-year follow up for 187 patients (96% reached two-year follow-up).…”