Treatment of coronary stent thrombosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Stents are usually placed in the proximal segments of major epicardial vessels, hence in-stent thrombotic occlusion clinically present as severe ischemia or infarction^[1].

Management[edit | edit source]

Emergent target lesion or target vessel revascularization is the treatment of choice in stent thrombosis to restore vessel patency.

• Revascularization may be carried out by PCI or in some instances, thrombolytics ^[2].

• If revascularization is not successful, urgent CABG should be considered.

• The probable cause for stent thrombosis should be evaluated as the treatment varies with etiology. The probable contributing factors are:
  • suboptimal stent apposition,
  • Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis^[1].
  • premature discontinuation of dual antiplatelet therapy,
  • clopidogrel resistance.

• If the patient develops stent thrombosis while on clopidogrel, it may suggest that the patient was not responsive to clopidrogrel therapy. TRITON TIMI 38 trial^[3] demonstrated that newer antiplatelet agents such as prasugrel^[4] may be used after weighing the risks of bleeding against benefits of decreased recurrence of stent thrombosis/coronary events.
• Patients who present with stent thrombosis after completing the recommended duration of treatment with clopidogrel restarting clopidogrel 75 mg daily along with aspirin and continuing for a minimum of one year should be considered.

Sources[edit | edit source]

The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI^[5]

References[edit | edit source]

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