title: [Coronary stent thrombosis: what's new in 2011?].
abstract: Stent thrombosis (ST) is a serious complication of percutaneous coronary interventions (PCI) with high mortality rates of up to 45%. Bare metal stents (BMS) and drug-eluting stents (DES) present similar rates of early (0.6%-1.2%) and late (0.3%-0.4%) ST. Very late ST is a specific entity after implantation of first-generation DES (sirolimus and paclitaxel) with an observed rate at 0.6% events/year. Strong predictors for early and late ST include: inadequate platelet inhibition, acute coronary syndromes (ACS), procedure-related factors such as stent underexpansion or dissection and patient-related factors such as diabetes, renal failure or a low left ventricular ejection fraction. Very late ST has been associated with delayed endothelial healing and drug-induced hypersensitivity reaction with exaggerated positive vessel remodeling, secondary incomplete stent apposition and paradoxical vasoconstriction. Dual antiplatelet therapy plays a key role in the prevention of ST. Premature dual antiplatelet therapy interruption (<6 months after PCI) and clopidogrel resistance (25% of patients) are strongly associated with ST. Finally, promising new pharmacologic agents such as prasugrel and ticagrelor have been introduced, permitting more predictable inhibition of platelet aggregation and enabling a further reduction in ST risk.
authors.affiliation: Cardiology, University Fribourg, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Oberhänsli
authors.forename: S
authors.initials: S
authors.lastname: Puricel
authors.forename: M
authors.initials: M
authors.lastname: Togni
authors.forename: S
authors.initials: S
authors.lastname: Cook
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000639:trends*; D003328:Coronary Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D005343:Fibrinolytic Agents; D005544:Forecasting; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors