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Coronary artery stent thrombosis: Clinical presentation and management

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


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".)


Patients with stent thrombosis usually present with an acute coronary syndrome (ACS; unstable angina, non-ST elevation myocardial infarction [NSTEMI], or ST-elevation MI [STEMI]). (See "Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department".)

In most cases, patients present with criteria for the diagnosis of acute STEMI [1]. (See "Criteria for the diagnosis of acute myocardial infarction".) In a report from the United States CathPCI Registry, among almost 7100 cases of stent thrombosis identified during a 16-month period, approximately 60 percent presented with STEMI, 23 percent with NSTEMI, and 17 percent with unstable angina [2]. Patients with early stent thrombosis (<1 month after stent placement) are somewhat more likely to develop cardiogenic shock than those with late (1 to 12 months) or very late (>12 months) stent thrombosis [2]. (See "Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction", section on 'Clinical presentation'.)


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Literature review current through: Sep 2016. | This topic last updated: Sep 2, 2014.
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