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STENT THROMBOSIS: WHICH IMPACT IN REAL CLINICAL PRACTICE?

Explore the definition, prediction, and impact of stent thrombosis, a rare but significant clinical event in interventional cardiology. Discover the factors contributing to stent thrombosis and the importance of individualized management strategies.

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STENT THROMBOSIS: WHICH IMPACT IN REAL CLINICAL PRACTICE?

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  1. STENT THROMBOSIS: WHICH IMPACT IN REAL CLINICAL PRACTICE? Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino Ospedale S. Giovanni Battista “Molinette” Torino gbiondizoccai@gmail.com

  2. Learning goals • What is stent thrombosis? • Can I predict stent thrombosis? • What is the real impact of stent thrombosis?

  3. Learning goals • What is stent thrombosis? • Can I predict stent thrombosis? • What is the real impact of stent thrombosis?

  4. Failing stents: thrombosis vs restenosis Schuchman, New Engl J Med 2006

  5. Stent thrombosis in the medical literature Google Scholar searched for “stent AND thrombosis” on 8 June 2010

  6. History of stent thrombosis IMPACT OF DUAL ANTIPLATELET THERAPY AND HIGH PRESSURE DILATION

  7. Definition of stent thrombosis • Acute occlusion of a previously patent stent • It is a clinical syndrome (presents with acute coronary syndrome or sudden death – if silent cannot be defined stent thrombosis) • It is not due to new plaque rupture at distant site • There was no severe restenosis with final occlusion

  8. Academic Research Consortium definitions • Definite: • Clinical syndrome (ACS or AMI) • and angiographic evidence of thrombus or occlusion • or pathologic evidence of acute thrombosis • Probable: • Unexplained death < 30 days • or target vessel AMI without angiographic confirmation of thrombosis or other identified culprit lesion • Possible: • Unexplained death after 30 days Cutlip et al, Circulation 2007

  9. Timing of stent thrombosis

  10. Learning goals • What is stent thrombosis? • Can I predict stent thrombosis? • What is the real impact of stent thrombosis?

  11. Mechanisms of thrombosis: Virchow's triad BLOOD FLOW VESSEL

  12. Mechanisms of stent thrombosis PATIENT FACTORS LESION FACTORS PROCEDURAL & MEDICAL RX FACTORS

  13. Genetic variability in risk of stent thrombosis Mega et al, New Engl J Med 2009

  14. Predicting thrombosis according to diabetes Machecourt et al, J Am Coll Cardiol 2009

  15. Predicting thrombosis according to stent length Moreno et al, J Am Coll Cardiol 2005

  16. What about late stent thrombosis? € McFadden et al, Lancet 2004

  17. Impact of antiplatelet therapy discontinuation Kimura et al, Circulation 2009

  18. Impact of antiplatelet therapy intensity 30-day results of the CURRENT-OASIS 7 Trial Mehta et al, ESC 2009

  19. Predictors of drug-eluting stent thrombosis Iakovou et al, JAMA 2005

  20. Predictors of stent thrombosis after ACS Van Werkum et al, J Am Coll Cardiol 2009

  21. Any synthesis possible? Capodanno et al, Clin Res Cardiol 2009

  22. Any synthesis possible? Capodanno et al, Clin Res Cardiol 2009

  23. Learning goals • What is stent thrombosis? • Can I predict stent thrombosis? • What is the real impact of stent thrombosis?

  24. Timing and incidence of stent thrombosis

  25. Incidence of stent thrombosis in Bern & Rotterdam Daemen et al, Lancet 2007

  26. Incidence of stent thrombosis in Sweden Lagerqvist et al, Circulation Int 2009

  27. Outlook after stent thrombosis Van Werkum et al, Circulation 2009

  28. Impact of BMS thrombosis Cutlip et al, Circulation 2001

  29. Impact of definite DES thrombosis Kuchulakanti et al, Circulation 2006

  30. Impact of definite or probable DES thrombosis Mauri et al, New Engl J Med 2007

  31. More on impact of DES thrombosis Daemen et al, Lancet 2007

  32. Stent thrombosis in further perspective Daemen et al, Lancet 2007

  33. Take home messages

  34. Take home messages • Stent thrombosis is a clinically important event, causing often death or myocardial infarction in those experiencing it • Stent thrombosis is however rare, but it can be predicted by patient and lesion factors, and modulated by procedural, pharmacologic and other treatment decisions • Thus, when addressing the issue of stent thrombosis, it is crucial to individualize management strategies in order to maximize benefits and minimize risks

  35. ThankyouforyourattentionForanycorrespondence: gbiondizoccai@gmail.comForthese and furtherslides on thesetopicsfeel free tovisit the metcardio.org website:http://www.metcardio.org/slides.html

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