Myocardial bridging is a potential risk factor of very late stent thrombosis of drug eluting stent

Abstract

SummaryDrug eluting stents have been implanted worldwide and used in nearly 90% of percutaneous coronary interventions in China. Although many randomized trials have confirmed the efficacy and safety profile of drug eluting stents, they were not powered to detect or exclude the effect of drug eluting stents on rare events such as stent thrombosis. Several mechanisms of very late stent thrombosis have been postulated, but are not widely accepted. Virchow’s triad describes the 3 main factors of thrombus formation – stasis of blood flow, endothelial injury and hypercoagulability. Myocardial bridging is a common congenital anomaly. Modern anatomy and angiography regard myocardial bridging as widespread, but its pathophysiological response is always ignored. According to Virchow’s triad, myocardial bridging negatively affect endothelial function, and the turbulent shear stress and intimal trauma predispose the vessel toward thrombus formation. Therefore, we question whether a relationship between myocardial bridging and very late stent thrombosis of drug eluting stents exists. Also, we propose that myocardial bridging might be a potential risk factor of very late stent thrombosis of drug eluting stents; coronary artery bypass grafting might be a promising and novel choice in the treatment of myocardial bridging with severe stenosis in the coronary artery.

The Outcome of Percutaneous Coronary Intervention for Significant Atherosclerotic Lesions in Segment Proximal to Myocardial Bridge at Left Anterior Descending Coronary Artery

“…24) Jiang reported that MB is a potential risk factor of stent thrombosis. 25,26) In our study, there was one case with acute intrastent thrombosis that was diagnosed 4 h after PCI in the MB group. We considered that the periodical pressing of MB, which leads to distinct hemodynamic changes and critical endothelial injuries, may play an important role in stent thrombosis.…”

Drug-Coated Balloon Treatment for ACS Induced by Myocardial Bridging: An Intravascular Ultrasound-Guided PCI

“… 1 Stent implantation may rectify the abnormal hemodynamics in patients with flow-limiting plaque but with concerns on perforation during stent deployment, stent fracture, 4 in-stent restenosis, 5 and stent thrombosis. 6 However, it may not be possible to avoid these interventional complications, especially when the target lesion is located at the MB segment. DCB could inhibit smooth muscle cell proliferation and thus eliminate stent thrombosis and reduce restenosis by directly contacting the antiproliferative drug with the vessel wall by a semicompliant balloon.…”

“…Intravascular imaging (e.g., IVUS) during coronary angiography may provide additional assistance in the recognition of plaque location and its spatial relationship with MB 1. Stent implantation may rectify the abnormal hemodynamics in patients with flow-limiting plaque but with concerns on perforation during stent deployment, stent fracture,4 in-stent restenosis,5 and stent thrombosis 6. However, it may not be possible to avoid these interventional complications, especially when the target lesion is located at the MB segment.…”

Untitled

“…Therefore, clinical features may manifest as angina-like chest pain, coronary spasm, acute coronary syndromes, left ventricular dysfunction, ventricular arrhythmias, and even sudden cardiac death. [42][43][44][45][46][47][48][49] Serious cardiac events are not common in the clinical setting. In addition, it is still arguable and uncertain whether MB can be directly attributable as the cause of the events.…”