title: Proximal atherosclerotic lesion as a cause of very late stent thrombosis.
abstract: Very late stent thrombosis is defined as in-stent thrombosis occurring after 1 year of an intra-coronary artery stent placement. Drug eluting stents have lately been criticized for increased reports of very late stent thrombosis. The exact cause of these very late stent thromboses is not clearly understood. Virchow's triad describes the three main factors of thrombus formation to be stasis of blood flow, endothelial injury and hypercoagulability. Based on Virchow's triad, we propose the cause of very late stent thrombosis to be formation of a de novo atherosclerotic lesion in the proximal segment of a stented artery. The de novo atherosclerotic lesion narrows the vessel lumen and causes stasis of blood flow in the distal stent. The de novo lesion can also cause myocardial ischemia creating a prothrombotic environment in the stented region. Stasis of blood flow and prothrombotic environment in the stented region can lead to the formation of very late stent thrombosis. Since atherosclerosis is a dynamic aging process in humans, we propose de novo proximal lesions in the coronary arteries can predispose to very late stent thrombosis.
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, New York, United States. gaddamsainath@gmail.com
authors.forename: Sainath
authors.initials: S
authors.lastname: Gaddam
authors.forename: Muniba
authors.initials: M
authors.lastname: Rizvi
authors.forename: Krishna Chaitanya
authors.initials: KC
authors.lastname: Nimmagadda
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Gala
authors.forename: Tarun
authors.initials: T
authors.lastname: Nagrani
authors.forename: Foad
authors.initials: F
authors.lastname: Ghavami
authors.forename: Donald
authors.initials: D
authors.lastname: McCord
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D050197:Atherosclerosis / Q000150:complications*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology*