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J Am Coll Cardiol. 2018 Apr 17;71(15):1676-1695. doi: 10.1016/j.jacc.2018.02.023.

Restenosis, Stent Thrombosis, and Bleeding Complications: Navigating Between Scylla and Charybdis.

Author information

1
Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Clinic Hospital, School of Medicine, Republic University, Montevideo, Uruguay.
2
Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
3
Department of Cardiology, Clinic Hospital, School of Medicine, Republic University, Montevideo, Uruguay.
4
Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
5
Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Victoria Johnson Research Laboratory, Virginia Commonwealth University, Richmond, Virginia.
6
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
7
Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. Electronic address: luis.guzman@vcuhealth.org.

Abstract

The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure. In the present era of interventional cardiology, the tradeoff between stent thrombosis, restenosis, and bleeding presents as a particularly complex challenge. In this review, the authors highlight major contributors of late/very late stent thrombosis while targeting stent restenosis, and they discuss evolutionary advances in stent technology and antiplatelet therapy, to further improve upon the care of patients with coronary artery disease.

KEYWORDS:

biodegradable polymers; bioresorbable vascular scaffold; bleeding; drug-eluting stent; percutaneous coronary intervention; stent restenosis; stent thrombosis

PMID:
29650125
DOI:
10.1016/j.jacc.2018.02.023

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