Thrombosis late stent

In 2006, however, focus shifted to another rare but potentially catastrophic event known as late stent thrombosis, which, in contrast to subacute thrombosis, occurs months to years after stent placement. It usually occurs before endothelialization is complete. For bare metal stents, this takes a few weeks. However, in drug eluting stents, this process of endotheliazation is delayed [68]. This complication... 

One of the significant factors promoting late stent thrombosis has been found to be premature discontinuation of dual antiplatelet therapy (aspirin and clopidrogel). In an analysis of 4,666 of patients undergoing initial PCI with BMS or DES, researchers from the Duke Heart center reported that longterm risk for death and major cardiac events was significantly increased among patients in the DES... 

Serruys PW, Daemen I. Are drug-eluting stents associated with a higher rate of late thrombosis than bare metal stents Late stent thrombosis a nuisance in both bare metal and drug-eluting stents. Circulation 2007 115 1433-1439. 

Late stent thrombosis (LST) after the use of DES is a rare complication. The SIR.TAX (7) trial has shown LST rates of 0.5% to 0.9% using DES. A case series (8) of four patients with LST who had stopped taking aspirin many months after DES implant has been reported. Registry data of DES use (9) reported a 0.7% late thrombosis rate, half of which patients died as a consequence. 

The exact mechanism of late stent thrombosis in DES is multi-factorial and includes factors related to inflammation, endothelial injury and incomplete healing. One million DES have been deployed worldwide... 

Hassan AK, Bergheanu SC, Stijnen T et al. Late stent malap-position risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis. Eur. Heart J. 2010 31 1172-1180. 

Despite the success of Cypher and Taxus , histopathological results showed incomplete endothelial coverage of the struts with persistent fibrin deposition and focal platelet aggregation at 16 months of Cypher implantation [46] and with DES in general when compared to BMS [47]. Moreover, late stent thrombosis (LST) was observed in more than half of the patients that received Cypher or Taxus 3-4 months after implantation [48]. 

On the other hand, ENDEAVOR III trials showed that Endeavor is associated with higher rates of restenosis when compared with Cypher [61] however, no very late stent thrombosis has been reported after 4 years of Endeavor use, showing long-term safety of Endeavor [60]. 

Reduced or abolished late stent thrombosis, facilitation of multiple surgeries in the lesion area, better imaging all these could be potential advantages of having a stent that actually disappears completely after it does its job. This led scientists to start developing fiiUy biodegradable stents (FBS) (Figure 4). 

Nakazawa, G., Finn, A.V., loner, M., et al. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients an autopsy study. Circulation 118(11), 1138-1145 (2008)... 

Cardiovascular coronary artery disease targeting late stent thrombosis PLEA stent Polymer blend with P(MPC3o-co-BMA7o) 48,49... 

A recent scientific direction for the treatment of coronaiy artery disease is concerned with the issue of late stent thrombosis, which is caused by a thrombotic occlusion within the implanted stents and reported to occur more than one year after implantation. In contrast to traditional stents made from biostable metals, new developments in this area make use of... 

Webster, M.W. and Ormiston, J.A. (2007) Drug-eluting stents and late stent thrombosis. Lancet, 370, 914-915. 

Ferrari, E., Benhamou, M., Cerboni, P., and Marcel, B. (2005) Coronary syndromes following aspirin withdrawal a special risk for late stent thrombosis. J. Am. Coll. Cardiol., 45, 456 —459. 

Venturini E, Magni L, Kounis NG. Amoxicillin-induced Kounis syndrome manifesting as late stent thrombosis. Int J Cardiol 2011 151(1) e26-8. 

Cook, S., Wenaweser, P., Togni, M., et al. (2007) Incomplete Stent Apposition and Very Late Stent Thrombosis After Dnig-Eluting Stent Implantation, Circulation, 115, 2426-34. 

The authors concluded that this complication had occurred because of platelet activation by the exogenous adrenahne. If so, it would be the first such case, causing very late stent thrombosis (more than 1 year after intervention), which seems unhkely other cases have been described, mostly associated with the withdrawal of antiplatelet drug therapy. 

Jackson CE, Dalzell J, Hogg KJ. Epinephrine treatment and anaphylaxis. An extraordinary case of very late stent thrombosis. Circ Cardiovasc Intervent 2009 2(1) 79-81. 

In comparison with BMS, first DES covered with drugs such as Sirolimus or Paclitaxel significantly reduced in-stent restenosis and the need for revascularization (procedure of stent implantation), but it turned out it can cause very late stent thrombosis, caused by delayed re-endothelialization and presence of a permanent polymer. Second-generation DES were designed with different frame and pol5mier layer that was covered with other drugs. DES of second generation still did not provide... 

Late stent thrombosis is more likely to occur iih these stents... 

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