How does stent thrombosis occur?
The primary factors contributing to stent thrombosis are inadequate stent deployment, incomplete stent apposition, residual stenosis, unrecognized dissection impairing blood flow, and noncompliance with dual antiplatelet therapy (DAPT). Noncompliance with DAPT is the most common cause of stent thrombosis.
Why do drug-eluting stents cause thrombosis?
The drug coating is depleted and there is no new tissue coating the stent struts. As a result, blood flows directly over a “bare” surface, a perfect set-up for thrombus formation.
What is restenosis and stent thrombosis?
Stent thrombosis is a thrombotic occlusion of a coronary stent. This is usually an acute process in contrast to restenosis, which is a gradual narrowing of the stent lumen due to neointimal proliferation. Stent thrombosis often results in an acute coronary syndrome, while restenosis often results in anginal symptoms.
How do you prevent a stent thrombosis?
Potential stent modifications to reduce stent thrombosis have included improving the biocompatibility of the stent and polymer, using bioabsorbable polymers, eliminating the polymer entirely, and/or using stent surface modifications to stimulate vascular endothelialization.
Why does stent restenosis occur?
What Causes Restenosis? Restenosis is caused by an overgrowth of scar tissue. When a stent is first placed, healthy tissue from the lining of your cell walls grows inside of it. This is good because it keeps your blood from clotting as it flows through the stent.
What does in stent restenosis mean?
Restenosis means that a section of blocked artery that was opened up with angioplasty or a stent has become narrowed again. There are many treatment options for patients who have restenosis after receiving a stent.
What are the current rates of stent thrombosis?
Current clinical registries and randomized trials with broad inclusion criteria show rates of ST at or <1% after 1 year and ∼0.2–0.4% per year thereafter; rates of clinical ISR are 5% respectively. Angiographic surveillance studies in large cohorts show rates of angiographic ISR of ∼10% with new-generation DES.
Which is the most common cause of stent failure?
The two major causes of stent failure are stent thrombosis (ST) and in-stent restenosis (ISR). The incidence of both has reduced considerably in recent years.
How does stent implantation affect the rate of restenosis?
Moreover, the additional advantage in terms of mechanical strength with stent implantation resulted in greater acute gain in luminal calibre and negation of the effects of vessel recoil and constrictive remodelling. This translated into a significantly lower rate of subsequent restenosis.
How is neoatherosclerotic change related to stent failure?
The advent of high-resolution intracoronary imaging has shown that in many cases of late stent failure neoatherosclerotic change within the stented segment represents a final common pathway for both thrombotic and restenotic events. In future, a better understanding of the pathogenesis of this process may translate into improved late outcomes.