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Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis.
For patients treated with DES who are to undergo subsequent procedures that mandate discontinuation of thienopyridine therapy, aspirin should be continued if at all possible and the thienopyridine restarted as soon as possible after the procedure because of concerns about late stent thrombosis.
However, delayed re-endothelialisation with DES results in an increased risk of late stent thrombosis (8,9).
The hypothesis that late stent thrombosis occurs due to late re-endothelialization in the coronary artery after DES mostly depends on angioscopy and autopsy studies (7).
The panel also recommended a postmarket, single-arm registry, of at least 5,000 patients followed to a minimum of five years with a primary endpoint of very late stent thrombosis (reformation of a clot) and a secondary endpoint evaluating death and myocardial infarction (heart attack).
Malapposed struts increase the risk of late stent thrombosis and focal in-stent restenosis.
Contemporary DES, which are designed to delay formation of new tissue, have been associated with delayed arterial healing and the prevalence of latent thrombus after five years, suggesting that patients may continue to be at risk for late and very late stent thrombosis (ST) long after PCI.
However, stent thrombosis rates after one year, known as very late stent thrombosis, were significantly lower with Endeavor (0.
However, a number of analyses have recently shown increased rates of late stent thrombosis in patients with DES.
XIENCE V also demonstrated a low rate of stent thrombosis between one and two years, defined as very late stent thrombosis, per Academic Research Consortium (ARC) definition of definite/probable stent thrombosis (0.
There probably is a true increase in the rate of late stent thrombosis in the on-label group, but importantly and equally convincingly there is no evidence of increased mortality or myocardial infarctions," Dr.
Rates of definite/probable very late stent thrombosis (VLST) were the same for the two devices (0.
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