Stent Thrombosis in the Modern Era

Cutlip, Donald E.; Baim, Donald S.; Ho, Kalon K.L.; Popma, Jeffrey J.; Lansky, Alexandra J.; Cohen, David J.; Carrozza, Joseph P.; Chauhan, Manish; Rodriguez, Orlando; Kuntz, Richard E.

doi:10.1161/01.cir.103.15.1967

Cited by 761 publications

(230 citation statements)

References 31 publications

(28 reference statements)

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“…[18][19][20] Premature discontinuation of antiplatelet therapy is strongly associated with stent thrombosis, 21,22 and some individuals are resistant to antiplatelet therapy. In the real world, more clinical trials and long-term follow-up is necessary to conclude the safety of DES, because some patients and more complex lesions are excluded from large clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Lim

Jeong

Hong

et al. 2008

Circ J

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iffuse, long coronary lesions are associated with an increased rate of restenosis and poor outcome, despite the development of percutaneous coronary intervention (PCI) techniques. [1][2][3] In particular, the implantation of multiple, overlapping, bare metal stents (BMS) has a high restenosis rate. 4,5 Use of drug-eluting stents (DES) results in a significant and sustained suppression of neointimal proliferation, and has greatly attenuated the relationship between stent length and restenosis rate. As a result, a long DES is usually selected for a diffuse coronary lesion, but if a residual segment of the lesion is left uncovered, additional stenting with some overlap is considered to eliminate the risk of a residual stent gap.Thus in the case of a diffuse, long coronary lesion, overlapping DES are used for complete lesion coverage, but there has been concern whether the overlapping DES have the effect of increasing the local drug dose or whether they Circulation Journal Vol.72, March 2008 could result in dose-related side-effects, such as delayed arterial healing and promotion of inflammation, as compared with overlapping BMS. 6 Few histopathological studies have been done on the response to overlapping DES or BMS, and even less so for the overlapping of different DES, such as the sirolimus-eluting stent (SES) or pacletaxel-eluting stent (PES). Therefore, the present study assessed the histopathological response and the effect on neointimal hyperplasia of overlapping DES or BMS in a porcine model of coronary in-stent restenosis (ISR). Methods Animal Study ProtocolThe animal study was approved by the Ethical Committee of the Chonnam National University Hospital. Study animals were female swine weighing 25-35 kg. To decrease the incidence of acute thrombosis after stenting, premedication with aspirin 100 mg and clopidogrel 75 mg/day was given for 7 days before the procedure. On the day of stent implantation, pigs were anesthetized with ketamine (20 mg/kg intramuscularly) and xylazine (2 mg/kg intramuscularly) and maintained on 3 L/min of supplemental oxygen continuously through a mask. After subcutaneous 2% lidocaine was administered at the cut-down site the left carotid artery was surgically exposed, and a 7F sheath was inserted. Continuous hemodynamic and surface electrocardiographic monitoring was maintained throughout the procedure. After 10,000 units of heparin were administered intravenously as a bolus

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Section: Discussionmentioning

confidence: 99%

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Lim

Jeong

Hong

et al. 2008

Circ J

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“…The frequency of stent thrombosis is 1-2% despite dual antiplatelet treatment [6]. Early stent thrombosis (i.e., within 30 days) is mostly due to a mechanical complication whereas late stent thrombosis, especially in the DES era, is due to suboptimal endothelialisation.…”

Section: Discussionmentioning

confidence: 99%

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

2011

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A 57-year-old male patient without cardiovascular history suffered an acute myocardial infarction and underwent drug-eluting stent implantation in the left anterior descending artery. A few days later, the right coronary artery was also stented (drug-eluting stent). Three days later, he was re-admitted to our hospital in cardiogenic shock. Emergent coronary angiography showed total occlusion of both stents. Platelet function analysis (PFA) showed attenuated platelet inhibition in response to clopidogrel treatment. The patient was the carrier of a loss-of-function polymorphism in the CYP2C19 gene, which has been associated with increased incidence of adverse thrombotic events. Antiplatelet therapy was switched to prasugrel and PFA revealed an adequate antiplatelet effect.

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“…2 Other studies examining ST with BMS show that clinical consequences of angiographic ST include a 64.4% incidence of death or MI at the time of ST and a six-month mortality of 8.9%. 50 For clinically defined ST events, the associated six-month mortality is as high as 20.8%. Due to such a high risk of death following ST, prevention of thrombosis is critical.…”

Section: Urgent Surgical Proceduresmentioning

confidence: 99%

Brief review: Coronary drug-eluting stents and anesthesia

Dalal

Stanlies

Souza

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Anesthesiologists managing patients with drug-eluting stents (DES) face the challenge of balancing the risks of bleeding vs perioperative stent thrombosis (ST). This article reviews DES and the influence of antiplatelet medications related to their use. A perioperative management algorithm is suggested. Novel P2Y12 antagonists currently under investigation, including cangrelor and prasugrel are considered, as well as their potential role in modification of perioperative cardiovascular risks and management of patients with DES.Source: A PubMed search of the relevant literature over the period 1985-2005 was undertaken using the terms "drug-eluting stent", "coronary artery stent", "bare metal stent", "antiplatelet medication", "aspirin", "clopidogrel."Principal findings: Delayed re-endothelialization may render both sirolimus-eluting and paclitaxel-eluting stents susceptible to thrombosis for a longer duration than bare metal stents. Stent thrombosis may be associated with resistance to antiplatelet medication. In patients with a DES, a preoperative cardiology consultation is essential. Elective surgery should be postponed if the duration between DES placement and noncardiac surgery is less than six months. For semi-emergent procedures, both aspirin and clopidogrel should be continued during surgery unless clearly contraindicated by the nature of the surgery. If the risk of bleeding is high, then modification of antiplatelet medications should be considered on a case-by-case basis. Conclusion: A profound increase in the number of patients with DES requires anesthesiologists to be familiar with their associated antiplatelet medications, and strategies for risk modification of ST and possible hemorrhagic complications in the perioperative setting. Objectif

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Stent Thrombosis in the Modern Era

Cited by 761 publications

References 31 publications

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

Brief review: Coronary drug-eluting stents and anesthesia

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