Stent thrombosis: a contemporary guide to definitions, risk factors, and management

Stent thrombosis remains a major complication following percutaneous coronary intervention, with significant morbidity and mortality implications. Despite advancements in drug-eluting stents and optimized pharmacotherapy, real-world registry data indicate that definite or probable stent thrombosis occurs in approximately 0.5% of percutaneous coronary intervention cases, with a 30-day mortality rate approaching 25% and a long-term risk exceeding 30% at 10 years. Stent thrombosis is classified based on timing into acute, subacute, late, and very late thrombosis, with subacute and very late stent thrombosis being the most prevalent. Clinical consequences include myocardial infarction, emergent revascularization, and heightened cardiovascular risk, necessitating timely recognition and intervention. Risk factors include patient characteristics, procedural variables, and lesion complexity, with recurrent stent thrombosis remaining a notable concern. This review explores the definitions, classifications, pathophysiology, and risk factors for stent thrombosis while discussing current strategies for prevention and management. Additionally, advancements in stent technology and pharmacologic interventions are examined, underscoring the need for a multidisciplinary approach to mitigate stent thrombosis incidence and improve patient outcomes.