The Dark Side of the Drug-Eluting Stent
The Dark Side of the Drug-Eluting Stent
The use of drug-eluting stents (DES) has increased exponentially in recent years. There appears to be little difference in short- to medium-term safety compared with bare-metal stenting (BMS). Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and not uncommonly in death. Late (>6 months) stent thrombosis is rare with BMS, but there is a concern that DES might be susceptible to thrombosis due to delayed endothelialisation.
The prolonged use of dual antiplatelet therapy (APT) with aspirin plus a thienopyridine (e.g. clopidogrel) is recommended. The premature discontinuation of APT in patients with DES without consultation with the treating cardiologist can result in stent thrombosis and adverse outcome.
The use of drug-eluting stents (DES) has increased exponentially in recent years with a significant improvement in the rates of re-stenosis, target lesion and target vessel revascularisation. There appears to be little difference in short- to medium-term safety compared with bare metal stenting (BMS). Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and marked adverse outcome. Typically, it happens in the first 3-10 days after the procedure leading almost always to an acute myocardial infarction and not uncommonly to death. Late (>6 months) stent thrombosis is rare with BMS, but there is a concern that DES might be susceptible to thrombosis due to delayed endothelialisation.
The prolonged use of dual antiplatelet therapy (APT) with aspirin plus a thienopyridine, usually clopidogrel, is recommended. In addition, optimal stent deployment at high pressure helps to reduce the likelihood of stent thrombosis. The premature discontinuation of APT in patients with DES, without consultation with the treating cardiologist, can result in stent thrombosis and adverse outcome.
We present two cases of DES thrombosis with resulting acute myocardial infarction following the premature discontinuation of APT.
The use of drug-eluting stents (DES) has increased exponentially in recent years. There appears to be little difference in short- to medium-term safety compared with bare-metal stenting (BMS). Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and not uncommonly in death. Late (>6 months) stent thrombosis is rare with BMS, but there is a concern that DES might be susceptible to thrombosis due to delayed endothelialisation.
The prolonged use of dual antiplatelet therapy (APT) with aspirin plus a thienopyridine (e.g. clopidogrel) is recommended. The premature discontinuation of APT in patients with DES without consultation with the treating cardiologist can result in stent thrombosis and adverse outcome.
The use of drug-eluting stents (DES) has increased exponentially in recent years with a significant improvement in the rates of re-stenosis, target lesion and target vessel revascularisation. There appears to be little difference in short- to medium-term safety compared with bare metal stenting (BMS). Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and marked adverse outcome. Typically, it happens in the first 3-10 days after the procedure leading almost always to an acute myocardial infarction and not uncommonly to death. Late (>6 months) stent thrombosis is rare with BMS, but there is a concern that DES might be susceptible to thrombosis due to delayed endothelialisation.
The prolonged use of dual antiplatelet therapy (APT) with aspirin plus a thienopyridine, usually clopidogrel, is recommended. In addition, optimal stent deployment at high pressure helps to reduce the likelihood of stent thrombosis. The premature discontinuation of APT in patients with DES, without consultation with the treating cardiologist, can result in stent thrombosis and adverse outcome.
We present two cases of DES thrombosis with resulting acute myocardial infarction following the premature discontinuation of APT.
