Thrombosis of a flexible coil coronary stent: Frequency, predictors and clinical outcome

Nath, F. C.; Muller, David W.M.; Ellis, Stephen G.; Rosenschein, Uri; Chapekis, Anthony T.; Quain, Laura; Zimmerman, Connie; Topol, Eric J.

doi:10.1016/0735-1097(93)90093-g

Cited by 177 publications

(52 citation statements)

References 15 publications

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“…For clinically defined stent thrombosis events, the associated 6-month mortality was 20.8%. These findings are consistent with the disastrous consequences of stent thrombosis reported in early studies 1,6,19,21,23,24 and are somewhat surprising because stent thrombosis events in our study patients were much more likely to occur while patients were still hospitalized. This is consistent, however, with a report by Hasdai et al 25 that showed poor clinical outcomes despite prompt restoration of blood flow after stent thrombosis.…”

Section: Cutlip Et Al Stent Thrombosissupporting

confidence: 82%

Stent Thrombosis in the Modern Era

Cutlip

Baim²,

Ho³

et al. 2001

Circulation

760

203

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Background-There are limited studies of stent thrombosis in the modern era of second-generation stents, high-pressure deployment, and current antithrombotic regimens. Methods and Results-Six recently completed coronary stent trials and associated nonrandomized registries that enrolled 6186 patients (6219 treated vessels) treated with Ն1 coronary stent followed by antiplatelet therapy with aspirin and ticlopidine were pooled for this analysis. Within 30 days, clinical stent thrombosis developed in 53 patients (0.9%). The variables most significantly associated with the probability of stent thrombosis were persistent dissection NHLBI grade B or higher after stenting (OR, 3.7; 95% CI, 1.9 to 7.7), total stent length (OR, 1.3; 95% CI, 1.2 to 1.5 per 10 mm), and final minimal lumen diameter within the stent (OR, 0.4; 95% CI, 0.2 to 0.7 per 1 mm). Stent thrombosis was documented by angiography in 45 patients (0.7%). Clinical consequences of angiographic stent thrombosis included 64.4% incidence of death or myocardial infarction at the time of stent thrombosis and 8.9% 6-month mortality. Conclusions-Stent thrombosis occurred in Ͻ1.0% of patients undergoing stenting of native coronary artery lesions and receiving routine antiplatelet therapy with aspirin plus ticlopidine. Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis. Continued efforts to eliminate this complication are warranted given the serious clinical consequences. (Circulation.

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Section: Cutlip Et Al Stent Thrombosissupporting

confidence: 82%

Stent Thrombosis in the Modern Era

Cutlip

Baim²,

Ho³

et al. 2001

Circulation

760

203

View full text Add to dashboard Cite

show abstract

“…[23][24][25][26] However, more recent methods using intravascular ultrasound, high-pressure post-dilatation, and an anti-platelet regimen with aspirin and ticlopidine have lead to a dramatic reduction in the rate of thrombosis to 0.5-2.5% [27][28][29][30][31][32] and most events occur within 5 days of the procedure. 31,32 The predisposing factors of stent thrombosis that have been identified in previous studies 29,31 include low ejection fraction, absence of hypertension, a combination of different stents, longer stent length, residual dissections, slow flow, and final lumen diameter, but no study has identified ETT or training as a predisposing or triggering factor.…”

Section: Predisposing Factors To Stent Thrombosismentioning

confidence: 99%

Safety and Implementation of Exercise Testing and Training After Coronary Stenting in Patients With Acute Myocardial Infarction.

Goto

Sumida

Ueshima

et al. 2002

Circ J

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n recent years, emergency percutaneous coronary intervention (PCI) using coronary stenting has rapidly become the treatment modality for patients with acute myocardial infarction (AMI). 1,2 In Japan, Watanabe et al reported that a multicenter survey showed 47.9% of 32,857 patients with AMI were treated by PCI in 1998PCI in -1999 The Japanese Coronary Intervention Study group reported that 37% of 2,673 patients with AMI who underwent PCI were treated with coronary stents in 1997, 4 and that the use of coronary stenting among all PCI procedures sharply increased from 39.5% in 1997 to 55.3% in 1999. 5 A recent report from the national registry in the USA showed that more than 70% of all PCI procedures involved placement of one or more coronary stents. 6 Exercise testing (ETT) is widely used as a routine method for detecting residual ischemia, assessment of exercise capacity and for the prognostic stratification of patients with AMI. The practice guidelines for patient management of AMI recommend a predischarge submaximal ETT to be performed at 4-6 days and a symptom-limited maximal ETT at 14-21 days after AMI. [7][8][9] Comprehensive (phase II) cardiac rehabilitation including exercise training (ie, exercise cardiac rehabilitation (ECR)) has been shown to improve functional capacity and quality of life and to reduce cardiovascular and total mortality in patients with AMI. 10,11 Therefore, both ETT and ECR are the standard modalities of post-AMI clinical assessment and treatment. 7 However, there are anecdotal case reports of thrombotic coronary occlusion associated with ETT after successful coronary stenting. [12][13][14] It is known that acute exercise can lead to a transient prothrombotic state in patients with coronary artery disease, 15 and questions have been raised about the safety of ETT after coronary stenting 12 because the true incidence of coronary thrombosis associated with ETT and ECR remains unclear. The guidelines do not have a specific statement about the safety or appropriate timing of ETT and ECR for patients with AMI who underwent coronary stenting. [7][8][9] In one study of the feasibility and safety of early ETT after AMI, patients who underwent PCI were excluded. 16 Thus, there is not general consensus on the safety and appropriate timing of ETT and ECR for patients with AMI who underwent coronary stenting. Accordingly, the purpose of the present study was to determine the incidence of subacute stent thrombosis related to ETT or exercise training and to obtain information about appropriate (safe The purpose of this study was to determine the incidence of subacute stent thrombosis related to exercise testing (ETT) or exercise training in cardiac rehabilitation (exercise cardiac rehabilitation (ECR)) and to clarify the appropriate timing of ETT and ECR in patients with acute myocardial infarction (AMI) treated with coronary stenting, because the safety and appropriate timing of ETT and ECR after coronary stenting for AMI have not been established. Forty-six institutes performing emergency percu...

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“…Stent thrombosis occurs in approximately 0.7-2.4% of patients undergoing coronary intervention 5,15) and may be more common in cases with emergency stent deployment. Platelet hyperaggregability promotes stent thrombosis, which is characterized by two occurrence peaks: the first is within 24 hours of stent deployment (acute stage) and the 2nd is at 2-14 days postdeployment (subacute stage).…”

Section: Discussionmentioning

confidence: 99%

Rescue Revascularization Therapy With a Stent-in-Stent Technique for Acute Intracranial Internal Carotid Artery Occlusion-Case Report-

Okazaki

Satomi

Satoh

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 45-year-old woman presented with progressive stroke due to occlusion of the left internal carotid artery at the level of the cavernous portion (C 3 /C 4 ). Revascularization was achieved by stent deployment following percutaneous transluminal angioplasty. Stent thrombosis occurred 7 days after primary stenting; it was successfully treated with the stent-in-stent technique. The patient was able to return to her independent life with no sequelae except for slight hemiparesis. In combination with appropriate antiplatelet treatment, the stent-in-stent technique should be considered as a rescue option in patients with re-occlusion of an intracranial stent.

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Thrombosis of a flexible coil coronary stent: Frequency, predictors and clinical outcome

Cited by 177 publications

References 15 publications

Stent Thrombosis in the Modern Era

Stent Thrombosis in the Modern Era

Safety and Implementation of Exercise Testing and Training After Coronary Stenting in Patients With Acute Myocardial Infarction.

Rescue Revascularization Therapy With a Stent-in-Stent Technique for Acute Intracranial Internal Carotid Artery Occlusion-Case Report-

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