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

Juan Torrado, Leo Buckley, Ariel Durán, Pedro Trujillo, Stefano Toldo, Juan Valle Raleigh, Antonio Abbate, Giuseppe Biondi-Zoccai, Luis A. Guzmán

Research output: Contribution to journalReview article

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.

Original languageEnglish
Pages (from-to)1676-1695
Number of pages20
JournalJournal of the American College of Cardiology
Volume71
Issue number15
DOIs
Publication statusPublished - Apr 17 2018

Keywords

  • biodegradable polymers
  • bioresorbable vascular scaffold
  • bleeding
  • drug-eluting stent
  • percutaneous coronary intervention
  • stent restenosis
  • stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Torrado, J., Buckley, L., Durán, A., Trujillo, P., Toldo, S., Valle Raleigh, J., Abbate, A., Biondi-Zoccai, G., & Guzmán, L. A. (2018). Restenosis, Stent Thrombosis, and Bleeding Complications: Navigating Between Scylla and Charybdis. Journal of the American College of Cardiology, 71(15), 1676-1695. https://doi.org/10.1016/j.jacc.2018.02.023