The annual meeting symposium will address several key topics related to stent thrombosis, including subacute thrombosis, occurring within a few days of stent implantation; late thrombosis, occurring months or years after stent implantation; and comparisons among drug-eluting stents.
In addition, speakers will focus on the possible causes of stent thrombosis. One common culprit is early discontinuation of double anticlotting medication, typically consisting of aspirin and clopidogrel. A substantial number of patients stop taking anticlotting medication before they should. Today, patients who are treated with drug-eluting stents are advised to continue anticlotting medications for at least 1 year. If it appears they cannot continue therapy for that long, many interventional cardiologists are choosing to implant a bare metal stent instead.
A far less common suspect in stent thrombosis is stent fracture. When stent struts separate, they leave a gap that exposes the artery and becomes the focal point for the build-up of scar tissue or even a blood clot. The risk of stent fracture is greatest at the point where stents overlap or where there is repeated bending of the stent with each cardiac contraction.
"As we have begun to extend stent use to very complex lesions, it has led to rare complications. One of them is stent fracture," said Jeffrey Popma, M.D., FSCAI, director of invasive cardiovascular services for Caritas Christi Health Care System, and director of the cardiac catheterization laboratory at St. Elizabeth's Medical Center, both in Boston. "Stent fracture is a rare but real cause of stent thrombosis."
Research is adding new pieces to the puzzle all the time, Dr. Dehmer said. For example, pathology studies suggest that in some patients, the artery may not heal properly after implantation of a drug-eluting stent,
Contact: Kathy Boyd David
Society for Cardiovascular Angiography and Interventions