Avoiding stent thrombosis: advances in technique, antiplatelet pharmacotherapy and stent design

Stent thrombosis (ST) is major complication that can occur any time following stent placement. Many studies have advanced our understanding of the risk factors and mechanisms contributing to ST. Beyond identifying high-risk characteristics, such as premature discontinuation of dual antiplatelet therapy or acute coronary syndrome on presentation, insights from these studies have led to refinements in procedural technique and stent design. Second-generation drug-eluting stents are commonly used in practice today, and have improved some of the characteristics found to promote ST with first-generation drug-eluting stents, and have resulted in lower rates of ST. In addition, the use of a novel and more potent antiplatelet therapy in high-risk patients has led to a reduction in subsequent ischemic events, including ST. Despite these important gains, several issues remain unresolved. Studies continue to evaluate the optimal duration of dual antiplatelet therapy following stent placement, which is challenged by s...