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The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion After Provisional Stenting of Coronary Bifurcation Lesions Physiologic Characteristics and Clinical Outcomes of Patients With Discordance Between FFR and iFR Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions Gut microbiota induces high platelet response in patients with ST segment elevation myocardial infarction after ticagrelor treatment Nicotine promotes vascular calcification via intracellular Ca21-mediated, Nox5-induced oxidative stress, and extracellular vesicle release in vascular smooth muscle cells Evolving understanding of the heterogeneous natural history of individual coronary artery plaques and the role of local endothelial shear stress Will Pulmonary Artery Denervation Really Have a Place in the Armamentarium of the Pulmonary Hypertension Specialist? Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Relationship between fractional flow reserve value and the amount of subtended myocardium Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study
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Review ArticleVolume 71, Issue 15, April 2018

JOURNAL：J Am Coll Cardiol. Article Link

Restenosis, Stent Thrombosis, and Bleeding Complications - Navigating Between Scylla and Charybdis

J Torrado, L Buckley, A Durán et al. Keywords: biodegradable polymers; bioresorbable vascular scaffold; bleeding; drug-eluting stent; PCI; stent restenosis; stent thrombosis

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.

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