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Coronary artery stent thrombosis: Clinical presentation and management

Author
Donald Cutlip, MD
Section Editors
Christopher P Cannon, MD
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Coronary artery stents, particularly drug-eluting stents, are used in the majority of patients who undergo percutaneous coronary intervention (PCI) to improve symptoms in patients with obstructive coronary artery disease. They function both to prevent abrupt closure of the stented artery soon after the procedure as well as to lower the need for repeat revascularization compared to balloon angioplasty alone (formerly referred to as percutaneous transluminal coronary angioplasty).

Stent thrombosis is an uncommon but serious complication of PCI with stenting. Most patients present with an acute coronary syndrome, usually with ST-segment elevation on the electrocardiogram. Its cause is total or subtotal thrombotic occlusion of a coronary artery by thrombus that originates in or close to an intracoronary stent. This finding is seen at the time of coronary angiography and it is necessary in most cases to secure the diagnosis. Death and myocardial infarction are not infrequent complications of stent thrombosis.

This topic will discuss the presentation and management of and outcomes after acute coronary artery stent thrombosis. Issues related to its incidence, timing, risk factors, and prevention are discussed elsewhere. (See "Coronary artery stent thrombosis: Incidence and risk factors" and "Long-term antiplatelet therapy after coronary artery stenting in stable patients".)

DEFINITIONS

Although earlier clinical trials posed a problem for comparing stent thrombosis rates due to non-standardized definition, since 2007, most trials have adopted the criteria and classification proposed by the Academic Research Consortium (ARC) [1].

Definite – Angiographic confirmation of a thrombus that originates in the stent or in the segment 5 mm proximal or distal to the stent, with or without vessel occlusion, which is associated with acute onset of ischemic symptoms at rest or electrocardiographic (ECG) signs of acute ischemia or typical rise and fall of in cardiac biomarkers within 48 hours of angiography or pathologic confirmation of stent thrombosis determined at autopsy or from tissue obtained following thrombectomy.

          

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 31 00:00:00 GMT+00:00 2016.
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References
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