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Timing of intervention in asymptomatic patients with valvular heart disease Effect of Luseogliflozin on Heart Failure With Preserved Ejection Fraction in Patients With Diabetes Mellitus Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: Meta-analysis of randomized trials Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomised trial and ten observational studies involving 19,619 patients Myofibroblast Phenotype and Reversibility of Fibrosis in Patients With End-Stage Heart Failure Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography DAPT, Our Genome and Clopidogrel From ACE Inhibitors/ARBs to ARNIs in Coronary Artery Disease and Heart Failure (Part 2/5) Intravascular Ultrasound to Guide Left Main Stem Intervention: A Sub-Study of the NOBLE Trial Efficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to Age: Insights From DAPA-HF
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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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