Journal of Thrombosis and Circulation: Open Access

Incidence and Predictors of Stent Thrombosis: Advancements in Prevention and Treatment

Den Damsbo^* Department of Clinical Pharmacology, Odense University, School of Medicine, Odense, Denmark
^*Correspondence: Den Damsbo, Department of Clinical Pharmacology, Odense University, School of Medicine, Odense, Denmark, Email:

Received: 19-Apr-2023, Manuscript No. JTCOA-23-21498; Editor assigned: 21-Apr-2023, Pre QC No. JTCOA-23-21498 (PQ); Reviewed: 05-May-2023, QC No. JTCOA-23-21498; Revised: 12-May-2023, Manuscript No. JTCOA-23-21498 (R); Published: 22-May-2023, DOI: 10.35248/2572-9462.23.9.229

Description

Stent thrombosis is a potentially life-threatening complication that can occur after coronary stent implantation. It is characterized by the formation of blood clots within the stent, leading to vessel occlusion and acute myocardial infarction. Despite significant advancements in interventional cardiology, stent thrombosis remains a concern, necessitating ongoing research and the development of new technologies to improve patient outcomes.

Incidence of stent thrombosis

The incidence of stent thrombosis varies depending on several factors, including patient characteristics, stent type, and procedural factors. According to various studies, the reported incidence of stent thrombosis ranges from 0.5% to 2.5% within the first year following stent implantation. The highest risk period for stent thrombosis is within the first 30 days, commonly referred to as early or acute stent thrombosis. However, late and very late stent thrombosis can also occur, albeit at lower rates. Late stent thrombosis typically occurs beyond one month but within one year, while very late stent thrombosis occurs more than one year after stent placement.

Predictors of stent thrombosis

Identifying predictors of stent thrombosis is crucial for risk stratification and optimizing patient care. Several factors have been associated with an increased risk of stent thrombosis. Patient-related factors include advanced age, female gender, diabetes mellitus, chronic kidney disease, and a history of prior myocardial infarction. Procedural factors such as stent under expansion, malposition, and incomplete stent apposition have also been linked to an increased risk of stent thrombosis. Dual Antiplatelet Therapy (DAPT) non-compliance or premature discontinuation is another critical factor associated with stent thrombosis.

New Technologies to Address Stent Thrombosis

Drug-Eluting Stents (DES): The introduction of DES has significantly reduced the incidence of stent thrombosis compared to Bare-Metal Stents (BMS). DES are stents coated with medications that inhibit the proliferation of smooth muscle cells and reduce the risk of restenosis. The continuous development of newer-generation DES with improved polymer coatings and novel drugs has further lowered the incidence of stent thrombosis.

Bioresorbable Vascular Scaffolds (BVS): BVS offer an innovative solution to prevent stent thrombosis. These scaffolds are made of biodegradable polymers that eventually dissolve, leaving the treated vessel in its natural state. Although BVS technology initially faced challenges, ongoing research aims to refine the design and enhance the mechanical properties to improve long-term outcomes and minimize the risk of thrombosis.

Optical Coherence Tomography (OCT): OCT is an imaging modality that provides high-resolution, cross-sectional images of the coronary arteries. It allows for precise assessment of stent deployment, expansion, and apposition, thereby enabling interventional cardiologists to optimize stent implantation. OCT-guided interventions have demonstrated a lower incidence of stent thrombosis compared to angiography-guided procedures.

Dual Antiplatelet Therapy (DAPT): Optimization Adequate duration and adherence to DAPT are essential for preventing stent thrombosis. Tailoring the duration of DAPT based on individual patient characteristics, stent type, and procedural factors can help minimize the risk of thrombosis while reducing bleeding complications. Recent studies have investigated strategies such as personalized antiplatelet therapy based on platelet function testing and genetic profiling to optimize DAPT and improve patient outcomes.

Bioactive coatings: Novel coatings applied to stents aim to promote endothelialisation and reduce thrombogenicity. Bioactive coatings release drugs or substances that enhance vessel healing and inhibit platelet activation. These coatings have shown promise in preclinical and early clinical studies and may offer an effective approach to reducing stent thrombosis.