Usefulness of Thrombus Aspiration for the Treatment of Coronary Stent Thrombosis

Mahmoud, Karim; Vlaar, Pieter J.; Heuvel, Ad F. M. van den; Hillege, Hans L.; Zijlstra, Felix; Smet, Bart J. G. L. de

doi:10.1016/j.amjcard.2011.07.044

Cited by 20 publications

(12 citation statements)

References 23 publications

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“…9 The mortality after EST was signifi-were consistent with previous studies. 2,6,9 Furthermore, whereas it is reported that thrombus aspiration for stent thrombosis tended to reduce mortality, 24 the present study found that thrombus aspiration for stent thrombosis during PCI was an independent predictor of cardiac death or non-fatal myocardial infarction, and it tended to be related to a low incidence of TLR. When PCI was performed for stent thrombosis, the improvement of coronary flow by thrombus aspiration could be associated with more favorable outcome in long-term follow-up.…”

Section: Discussioncontrasting

confidence: 45%

Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

Kubo

Kadota

Ichinohe

et al. 2014

Circ J

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Section: Discussioncontrasting

confidence: 45%

Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

Kubo

Kadota

Ichinohe

et al. 2014

Circ J

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“…A total of 23 studies were included in this systematic review and meta-analysis [4,7-28], of which 13 were included in the in-hospital analyses and 10 in the 30-day analyses (Tables 1 and 2 ). More specifically, 12 studies had data on in-hospital death [4,7,10,12,14-16,21,24,25,27,28] and 5 studies reported data on in-hospital MI [10,12,16,22,27], 10 studies reported on 30-day death [8,9,11,13,17-20,23,26] , 3 on 30-day MI [8,9,11] and one evaluated the cost of the index hospitalization due to angiographically-confirmed ST [4]. …”

Section: Resultsmentioning

confidence: 99%

“…Of note, while most of the studies we identified in our systematic review exclude the ST-defining ischemic event from their MI endpoint, not all did. Thus, we had to exclude a small number of studies [23,31] from our MI meta-analysis because they either stated they included the ST-defining MI or they did not make it clear they did not (albeit efforts to contact authors for clarification were made, with some success).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Consequences of Angiographically-Confirmed Coronary Stent Thrombosis

et al. 2013

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ObjectivesTo conduct a meta-analysis to quantify the real-world incidence of in-hospital or 30-day death or myocardial infarction (MI), and angiographically-confirmed ST-related treatment costs.BackgroundThe short-term clinical and economic consequences of coronary stent thrombosis (ST) are thought to be significant.MethodsWe searched MEDLINE, Embase and Scopus from January 2000-July 2012 to identify observational/registry studies that evaluated a cohort of ≥25 patients experiencing angiographically-confirmed thrombosis of a drug-eluting or bare-metal stent, required the use of dual-antiplatelet therapy for guideline-recommended durations, and reported incidences of in-hospital or 30-day death or MI and/or ST-related treatment costs. Incidences and costs from each study were pooled using random-effects meta-analysis.ResultsTwenty-three studies were included. Of the 13 studies reporting in-hospital outcomes, 12 (N=8,832 STs) reported mortality data, with the pooled incidence rate estimated to be 7.9%, 95%CI=5.4%-11.3%, I2=86%. Ten studies (N=1,294 STs) reported 30-day death, with a pooled incidence of 11.6%, 95%CI=8.8%-15.1%, I2=55%. Patients experiencing early ST (within 30-days of implant) had higher in-hospital and 30-day mortality than those experiencing very-late ST (interaction p<0.04 for both). Stent type had no significant effect on in-hospital or 30-day mortality. In the 5 studies (N=542 STs) and 3 studies (N=180 STs) reporting in-hospital and 30-day MI, respectively, the pooled incidence rates were 6.1%, 95%CI=2.1%-16.2%, I2=88% and 9.5%, 95%CI=3.8%-22.0%, I2=65%. One study reported costs associated with ST, estimating the median/patient cost of hospitalization to treat early ST at $11,134 (in 2000US$).ConclusionsRegardless of stent type used, the short-term consequences of coronary ST appear significant.

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“…From a mechanical standpoint, careful thrombus aspiration appears essential (7)(8)(9)(10)(11). Recent studies suggest that in these patients, thrombus aspiration is associated, not only with better epicardial and microvascular reperfusion (10), but also with favorable clinical outcomes (11).…”

Section: Treatment Of Stent Thrombosismentioning

confidence: 99%

New Insights on Stent Thrombosis

Alfonso

Sandoval

2012

JACC: Cardiovascular Interventions

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Stents represent the default strategy in interventional cardiology (1). In the last decade, drug-eluting stents (DES) have been widely embraced because of their unprecedented ability to drastically inhibit neointimal proliferation. Accordingly, the clinical need for repeat revascularization has been significantly reduced despite the widespread use of coronary interventions in ever increasingly complex clinical and anatomic scenarios. However, the risk of stent thrombosis (ST) remains an issue of serious concern (2). DES have been unable to reduce the incidence of this complication but have changed its temporal pattern of presentation, widening the vulnerable period. Actually, this problem has prevented an even wider penetration of DES (1,2). See page 131ST remains a very rare phenomenon, but it may be associated with devastating clinical consequences (2). Early series suggested that ST was associated with very high mortality (3). Subsequent studies-from less selected patient populations-suggested that the consequences of ST were not so dismal, although clinical outcomes were still poorer than those seen in de novo patients with acute myocardial infarction (4,5). The explanation for this particularly adverse prognosis remains obscure, but the uniquely large thrombus burden seen in patients with ST might play a role (2). Likewise, the underlying mechanisms leading to ST remain poorly elucidated but appear multifaceted. Mechanical factors, delayed endothelialization, and hypersensitivity reactions have all been considered as "local factors" able to generate a "vulnerable stent." Furthermore, from a "systemic" perspective, any potent stimulus triggering platelet activation might shift the delicate coagulation balance toward a prothrombotic milieu precipitating the acute event. However, despite intense research efforts, the incidence, predictive factors, underlying pathological substrate, clinical implications, and management of ST still remain incompletely elucidated. All previous studies on ST suffer from a common main limitation: relatively small sample sizes. Therefore, larger studies, with enough power to address the unmet need of information still required on this dreadful complication, are eagerly awaited.In this issue of JACC: Cardiovascular Interventions, Armstrong et al. (6) present the results of an impressively large cohort of patients with ST (7,315 episodes of ST) included in the CathPCI Registry. This study provides unique insights that complement our current knowledge on ST. Present Study In the current study, 7,079 patients with ST (1,391 early [19.6%], 1,370 late [19.4%], and 4,318 very late [61%]), of 401,662 patients (1.8%) with acute coronary syndromes prospectively included in the CathPCI Registry, were analyzed (6). Two-thirds of patients received DES and experienced very late ST. Overall in-hospital mortality was only 4.5% and was similar for bare-metal stents (BMS) and DES ST. Patients with early ST showed a higher prevalence of black race, diabetes, and prior heart failure. They also presen...

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Usefulness of Thrombus Aspiration for the Treatment of Coronary Stent Thrombosis

Cited by 20 publications

References 23 publications

Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

Short-Term Consequences of Angiographically-Confirmed Coronary Stent Thrombosis

New Insights on Stent Thrombosis

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