Key result
Second-generation DES cut stent thrombosis to <1%, but bioresorbable scaffolds raise new thrombosis concerns.
This review highlights the updated pathophysiology and risk factors for stent and scaffold thrombosis to improve risk stratification in the modern PCI era.
Stent thrombosis warrants ongoing clinical vigilance despite <1% rates; extends risk factor insights for stratification while leaving scaffold concerns open.
Stent thrombosis (ST) is uncommon yet constitutes the most feared complication following percutaneous coronary intervention. Although its incidence is now <1% within a year after stenting in patients receiving second or later-generation drug-eluting stents (DES), compared to those in the first-generation DES-era, the clinical impact of ST is still high, because the majority of cases with ST are complicated by critical consequences, including myocardial infarction and even sudden cardiac death. Moreover, the pathophysiology and risk factors leading to ST were recently re-recognised, as bioresorbable scaffolds (or biodegradable vascular scaffolds) have now been developed, and concerns have arisen regarding scaffold thrombosis, which serves as another ‘ST’. Accumulating evidence through the bare-metal stent and DES-era has identified clinical factors associated with increased risk of ST, such as patient-related, lesion-related, procedure-related, and post-procedure-related risk factors. Therefore, this short review describes updated pathophysiology and contributing risk factors for stent (or scaffold) thrombosis, which are useful for risk stratification in patients with coronary artery disease in the late metallic DES-era or at the beginning of the bioresorbable scaffolds era.
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Wada et al. (2017) conducted a review in Coronary artery disease. Drug-eluting stents and bioresorbable scaffolds was evaluated. Although the incidence of stent thrombosis has decreased to less than 1% with second-generation drug-eluting stents, it remains a critical complication with emerging concerns regarding scaffold thrombosis in bioresorbable scaffolds.
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