Is there a higher risk of stent thrombosis in bifurcation lesions, or is this related to the technique?

Ioannis Iakovou, Kazushige Kadota, Spyridon Papamentzelopoulos, Gregory Pavlides, Kazuaki Mitsudo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Bifurcation lesions and bifurcation stenting have been reported to be risk factors of stent thrombosis (ST). ST is a complex process that may be the culmination of device, patient, lesion and procedural factors. The strategy of provisional SB stenting is widely accepted for suitable bifurcation lesions, and is accompanied by low rates of ST. However, it is not applicable to all patients, and in these clinical scenarios (approx. 10%), there is no consensus on the best option for elective stenting with two stents regarding the incidence of ST. Excessive metal scaffolding, such as in the classical crush technique, should be avoided. Further accumulation of long-term data from larger clinical registries and randomised studies will be needed to elucidate the best technique regarding the avoidance of ST in bifurcation treatment. Dedicated bifurcation stents tailored for each type of lesion could resolve this issue, especially the excess of metal protruding in the vessel lumen or crushed onto the wall. However, they need to be tested in upcoming and ongoing trials. Stent thrombosis (ST) is the sudden occlusion of a stented coronary artery due to thrombus formation. Despite major improvements of antiplatelet therapy, thrombotic events remain the primary cause of death after percutaneous coronary interventions (PCI). 1,2 The clinical consequences of ST are frequently catastrophic and include death in 20% to 48% or major myocardial infarction (MI) in 60% to 70% of the cases. 1-3 In the drug-eluting stent era, ST and especially very late ST remains a concern of coronary intervention. Bifurcation lesions and bifurcation stenting have been reported to be the risk factors for ST.3 ST is a complex process that may be a culmination of device, patient, lesion, and procedural factors. 4 The exact cause of the higher risk of ST in bifurcation lesions is unknown although pathologic studies have suggested that the arterial branch points are predisposed to development of atherosclerotic plaque, thrombus, and inflammation because they are foci of low shear stress. 5-8

Original languageEnglish (US)
JournalEuroIntervention
Volume6
Issue numberSUPPL. J
StatePublished - Dec 1 2010

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Stents
Thrombosis
Metals
Equipment and Supplies
Drug-Eluting Stents
Atherosclerotic Plaques
Percutaneous Coronary Intervention
Registries
Cause of Death
Coronary Vessels
Myocardial Infarction
Inflammation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Is there a higher risk of stent thrombosis in bifurcation lesions, or is this related to the technique? / Iakovou, Ioannis; Kadota, Kazushige; Papamentzelopoulos, Spyridon; Pavlides, Gregory; Mitsudo, Kazuaki.

In: EuroIntervention, Vol. 6, No. SUPPL. J, 01.12.2010.

Research output: Contribution to journalArticle

Iakovou, I, Kadota, K, Papamentzelopoulos, S, Pavlides, G & Mitsudo, K 2010, 'Is there a higher risk of stent thrombosis in bifurcation lesions, or is this related to the technique?', EuroIntervention, vol. 6, no. SUPPL. J.
Iakovou, Ioannis ; Kadota, Kazushige ; Papamentzelopoulos, Spyridon ; Pavlides, Gregory ; Mitsudo, Kazuaki. / Is there a higher risk of stent thrombosis in bifurcation lesions, or is this related to the technique?. In: EuroIntervention. 2010 ; Vol. 6, No. SUPPL. J.
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abstract = "Bifurcation lesions and bifurcation stenting have been reported to be risk factors of stent thrombosis (ST). ST is a complex process that may be the culmination of device, patient, lesion and procedural factors. The strategy of provisional SB stenting is widely accepted for suitable bifurcation lesions, and is accompanied by low rates of ST. However, it is not applicable to all patients, and in these clinical scenarios (approx. 10{\%}), there is no consensus on the best option for elective stenting with two stents regarding the incidence of ST. Excessive metal scaffolding, such as in the classical crush technique, should be avoided. Further accumulation of long-term data from larger clinical registries and randomised studies will be needed to elucidate the best technique regarding the avoidance of ST in bifurcation treatment. Dedicated bifurcation stents tailored for each type of lesion could resolve this issue, especially the excess of metal protruding in the vessel lumen or crushed onto the wall. However, they need to be tested in upcoming and ongoing trials. Stent thrombosis (ST) is the sudden occlusion of a stented coronary artery due to thrombus formation. Despite major improvements of antiplatelet therapy, thrombotic events remain the primary cause of death after percutaneous coronary interventions (PCI). 1,2 The clinical consequences of ST are frequently catastrophic and include death in 20{\%} to 48{\%} or major myocardial infarction (MI) in 60{\%} to 70{\%} of the cases. 1-3 In the drug-eluting stent era, ST and especially very late ST remains a concern of coronary intervention. Bifurcation lesions and bifurcation stenting have been reported to be the risk factors for ST.3 ST is a complex process that may be a culmination of device, patient, lesion, and procedural factors. 4 The exact cause of the higher risk of ST in bifurcation lesions is unknown although pathologic studies have suggested that the arterial branch points are predisposed to development of atherosclerotic plaque, thrombus, and inflammation because they are foci of low shear stress. 5-8",
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