Late Thrombosis: A Problem Solved

Coronary angioplasty has vastly improved both in technique and devices since the first angioplasty in 1977. Currently, stent implantation is used almost ubiquitously, despite being developed originally to treat vessel threatening dissections. Newer concepts including absorbable polymers or fully bioabsorbable scaffolds are constantly being developed. However, we find the concept of no permanent implant whilst still delivering a chemotherapeutic drug to reduce restenosis very attractive given the long term implications of a metallic stent, which include restenosis, late thrombosis and neo-atheroma formation. The use of a drug-coated balloon-only approach to de novo angioplasty will avoid the late thrombotic problems whilst also reducing early restenosis, simplifying the procedure and reducing the dual antiplatelet duration to 1 month. We review the current literature and highlight our practice with regard to use of drug-coated balloons in treatment of de novo coronary artery disease.

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Late thrombosis of coronary bare-metal stent: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0604155a ◽

2006 ◽

Vol 134 (3-4) ◽

pp. 155-158 ◽

Cited By ~ 1

Author(s):

Svetlana Apostolovic ◽

Zoran Perisic ◽

Miloje Tomasevic ◽

Goran Stankovic ◽

Milan Pavlovic ◽

...

Keyword(s):

Stent Thrombosis ◽

Bare Metal Stent ◽

Drug Eluting Stent ◽

Bare Metal ◽

Metal Stent ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Drug Eluting ◽

Late Thrombosis ◽

And Control

Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI). Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS). Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months) thrombosis of coronary bare-metal stent (BMS) is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU) was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.

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Late thrombosis of a drug-eluting stent during combined anti-platelet therapy in a clopidogrel nonresponsive diabetic patient: Shall we routinely test platelet function ?

Thrombosis and Haemostasis ◽

10.1160/th07-01-0032 ◽

2007 ◽

Vol 97 (05) ◽

pp. 862-865 ◽

Cited By ~ 4

Author(s):

Andreas Bonz ◽

Martin Eigenthaler ◽

Johann Bauersachs ◽

Andreas Schäfer

Keyword(s):

Diabetic Patient ◽

Platelet Function ◽

Drug Eluting Stent ◽

Anti Platelet Therapy ◽

Drug Eluting ◽

Late Thrombosis

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Unanswered Questions — Drug-Eluting Stents and the Risk of Late Thrombosis

New England Journal of Medicine ◽

10.1056/nejmp068305 ◽

2007 ◽

Vol 356 (10) ◽

pp. 981-984 ◽

Cited By ~ 187

Author(s):

William H. Maisel

Keyword(s):

Drug Eluting Stents ◽

Drug Eluting ◽

Late Thrombosis

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Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.26913 ◽

2017 ◽

Vol 89 (5) ◽

pp. 876-879 ◽

Cited By ~ 6

Author(s):

Amisha Patel ◽

Tamim Nazif ◽

Gregg W. Stone ◽

Ziad A. Ali

Keyword(s):

Bioresorbable Vascular Scaffold ◽

Aneurysm Formation ◽

Vascular Scaffold ◽

Late Thrombosis

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Multimodality Imaging of a Very Late Thrombosis of a Sutureless Aortic Prosthesis

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.11.019 ◽

2018 ◽

Vol 11 (4) ◽

pp. e25-e26

Author(s):

Francesco Melillo ◽

Damiano Regazzoli ◽

Francesco Ancona ◽

Luca Baldetti ◽

Cristina Capogrosso ◽

...

Keyword(s):

Multimodality Imaging ◽

Aortic Prosthesis ◽

Late Thrombosis

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Stented Artery Biomechanics in the Presence of Stenoses and Tapering

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-176143 ◽

2007 ◽

Author(s):

Lucas H. Timmins ◽

Clark A. Meyer ◽

Michael R. Moreno ◽

James E. Moore

Keyword(s):

Material Properties ◽

Drug Eluting Stents ◽

Bare Metal ◽

Stent Design ◽

Artery Wall ◽

Technological Advances ◽

Drug Eluting ◽

Late Thrombosis ◽

Induced Stresses ◽

Human Implantation

The implantation of a balloon expandable stent induces chronic stent-induced stresses on the artery wall. These highly non-physiologic stresses can provoke inflammation and smooth muscle cell proliferation. Ultimately, this cascade of events leads to restenosis, or the development of a new blockage in the stented artery. Since the initial human implantation of balloon expandable stents, technological advances in stent design, material properties, and deliverability have expanded the application and success rate of the procedure. More recently, anti-restenotic strategies such as drug-eluting stents have aimed to counteract the restenosis process. While clinical trials have demonstrated the success of drug eluting stents in coronary arteries [1], risk of late thrombosis [2] and failure to prevent restenosis in peripheral arteries [3] has limited this technology. A further investigation into the artery wall stresses induced by stent implantation, and the pursuit of strategies to minimize them could reduce the restenosis rates for both bare metal and drug-eluting stents.

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