Late and Very Late Stent Thrombosis in the Era of Second-Generation Drug-Eluding Stents

Jaya Mallidi, *Amir Lotfi

Division of Cardiology, Baystate Medical Center, Tufts University, Springfield, Massachusetts, USA
*Correspondence to amir.lotfi@bhs.org

Disclosure: The authors have declared no conflicts of interest.
Received: 24.11.15 Accepted: 10.03.16
Citation: EMJ. 2016;1[3]:85-93.

Abstract

Stent thrombosis is a life-threatening complication of percutaneous coronary intervention that often results in ST-segment myocardial infarction or sudden cardiac death. First-generation drug-eluting stents (DESs) are associated with an increased risk of late and very late stent thrombosis compared with bare- metal stents due to delayed endothelialisation of the stent struts. The second-generation DES design includes a number of improved features (thinner stent struts, fluorinated copolymers, and different anti-proliferative agents) to decrease the risk of late stent thrombosis. Currently, the cobalt-chromium everolimus-eluting stent, a second-generation stent, has the lowest risk of stent thrombosis when compared with the available alternatives. Given the improved design of second-generation stents, a shorter duration of dual antiplatelet therapy of 6 months may be enough to reduce the rate of bleeding complications without increasing the risk of adverse cardiovascular events. Future large-scale randomised trials are required to evaluate the safety and efficacy of third-generation DESs which feature bioresorbable polymers and scaffolds.

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