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Management of two major complications in the cardiac catheterisation laboratory: the no-reflow phenomenon and coronary perforations Advances in Coronary No-Reflow Phenomenon-a Contemporary Review A Randomized Trial to Assess Regional Left Ventricular Function After Stent Implantation in Chronic Total Occlusion The REVASC Trial Optimal Stenting Technique for Complex Coronary Lesions Intracoronary Imaging-Guided Pre-Dilation, Stent Sizing, and Post-Dilation A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable Scaffold and Metallic Everolimus-Eluting Stents Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes Better Prognosis After Complete Revascularization Using Contemporary Coronary Stents in Patients With Chronic Kidney Disease Management of Patients With NSTE-ACS: A Comparison of the Recent AHA/ACC and ESC Guidelines Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents in Patients With Small Vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE Randomized Trial Percutaneous Support Devices for Percutaneous Coronary Intervention
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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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